Cost-effectiveness of second-generation antipsychotics and perphenazine in a randomized trial of treatment for chronic schizophrenia

Robert A. Rosenheck, Douglas Leslie, Jody Sindelar, Edward A. Miller, Haiqun Lin, T. Scott Stroup, Joseph McEvoy, Sonia M. Davis, Richard S.E. Keefe, Marvin Swartz, Diana O. Perkins, John K. Hsiao, Jeffrey Lieberman

Research output: Contribution to journalArticle

230 Citations (Scopus)

Abstract

Background: Second-generation antipsychotics have largely replaced first-generation antipsychotics for the treatment of schizophrenia, but a large-scale cost/effectiveness analysis has not been attempted. Method: Patients with schizophrenia (N=1,493) were assigned to treatment with a first-generation antipsychotic (perphenazine) or one of four second-generation drugs (olanzapine, quetiapine, risperidone, or ziprasidone) and followed for up to 18 months. Patients with tardive dyskinesia were prohibited from assignment to perphenazine. Patients could be reassigned at any time to another second-generation drug, including clozapine, but not to perphenazine. The cost analysis included medications plus health services use. Quality-adjusted life year (QALY) ratings were assessed on the basis of Positive and Negative Syndrome Scale (PANSS) subscale scores and side effects. An intention-to-treat analysis included all available observations, classified by initial drug assignment, and costs of reassignment of most patients to another second-generation drug. The analysis was repeated considering only treatment on initially assigned medications. Results: Although QALY ratings, PANSS scores, and other quality of life measures indicated modest improvement over 18 months, there were no significant differences between perphenazine and any second-generation medication. Average total monthly health care costs were $300-$600 (20%-30%) lower for perphenazine than for second-generation antipsychotics because of lower drug cost. Differences in costs remained when maximally discounted drug prices were used for all patients and when only observations during treatment with the first medication were included. Conclusions: Treatment with perphenazine was less costly than treatment with second-generation antipsychotics with no significant differences in measures of effectiveness. However, the trial was limited by a high dropout rate, and longer-term neurological and metabolic side effects require further study.

Original languageEnglish (US)
Pages (from-to)2080-2089
Number of pages10
JournalAmerican Journal of Psychiatry
Volume163
Issue number12
DOIs
StatePublished - Jan 1 2006

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Perphenazine
Antipsychotic Agents
Cost-Benefit Analysis
Schizophrenia
Drug Costs
Quality-Adjusted Life Years
olanzapine
Pharmaceutical Preparations
Therapeutics
Costs and Cost Analysis
Intention to Treat Analysis
Risperidone
Clozapine
Health Care Costs
Health Services
Quality of Life

All Science Journal Classification (ASJC) codes

  • Psychiatry and Mental health

Cite this

Rosenheck, Robert A. ; Leslie, Douglas ; Sindelar, Jody ; Miller, Edward A. ; Lin, Haiqun ; Stroup, T. Scott ; McEvoy, Joseph ; Davis, Sonia M. ; Keefe, Richard S.E. ; Swartz, Marvin ; Perkins, Diana O. ; Hsiao, John K. ; Lieberman, Jeffrey. / Cost-effectiveness of second-generation antipsychotics and perphenazine in a randomized trial of treatment for chronic schizophrenia. In: American Journal of Psychiatry. 2006 ; Vol. 163, No. 12. pp. 2080-2089.
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abstract = "Background: Second-generation antipsychotics have largely replaced first-generation antipsychotics for the treatment of schizophrenia, but a large-scale cost/effectiveness analysis has not been attempted. Method: Patients with schizophrenia (N=1,493) were assigned to treatment with a first-generation antipsychotic (perphenazine) or one of four second-generation drugs (olanzapine, quetiapine, risperidone, or ziprasidone) and followed for up to 18 months. Patients with tardive dyskinesia were prohibited from assignment to perphenazine. Patients could be reassigned at any time to another second-generation drug, including clozapine, but not to perphenazine. The cost analysis included medications plus health services use. Quality-adjusted life year (QALY) ratings were assessed on the basis of Positive and Negative Syndrome Scale (PANSS) subscale scores and side effects. An intention-to-treat analysis included all available observations, classified by initial drug assignment, and costs of reassignment of most patients to another second-generation drug. The analysis was repeated considering only treatment on initially assigned medications. Results: Although QALY ratings, PANSS scores, and other quality of life measures indicated modest improvement over 18 months, there were no significant differences between perphenazine and any second-generation medication. Average total monthly health care costs were $300-$600 (20{\%}-30{\%}) lower for perphenazine than for second-generation antipsychotics because of lower drug cost. Differences in costs remained when maximally discounted drug prices were used for all patients and when only observations during treatment with the first medication were included. Conclusions: Treatment with perphenazine was less costly than treatment with second-generation antipsychotics with no significant differences in measures of effectiveness. However, the trial was limited by a high dropout rate, and longer-term neurological and metabolic side effects require further study.",
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Rosenheck, RA, Leslie, D, Sindelar, J, Miller, EA, Lin, H, Stroup, TS, McEvoy, J, Davis, SM, Keefe, RSE, Swartz, M, Perkins, DO, Hsiao, JK & Lieberman, J 2006, 'Cost-effectiveness of second-generation antipsychotics and perphenazine in a randomized trial of treatment for chronic schizophrenia', American Journal of Psychiatry, vol. 163, no. 12, pp. 2080-2089. https://doi.org/10.1176/ajp.2006.163.12.2080

Cost-effectiveness of second-generation antipsychotics and perphenazine in a randomized trial of treatment for chronic schizophrenia. / Rosenheck, Robert A.; Leslie, Douglas; Sindelar, Jody; Miller, Edward A.; Lin, Haiqun; Stroup, T. Scott; McEvoy, Joseph; Davis, Sonia M.; Keefe, Richard S.E.; Swartz, Marvin; Perkins, Diana O.; Hsiao, John K.; Lieberman, Jeffrey.

In: American Journal of Psychiatry, Vol. 163, No. 12, 01.01.2006, p. 2080-2089.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cost-effectiveness of second-generation antipsychotics and perphenazine in a randomized trial of treatment for chronic schizophrenia

AU - Rosenheck, Robert A.

AU - Leslie, Douglas

AU - Sindelar, Jody

AU - Miller, Edward A.

AU - Lin, Haiqun

AU - Stroup, T. Scott

AU - McEvoy, Joseph

AU - Davis, Sonia M.

AU - Keefe, Richard S.E.

AU - Swartz, Marvin

AU - Perkins, Diana O.

AU - Hsiao, John K.

AU - Lieberman, Jeffrey

PY - 2006/1/1

Y1 - 2006/1/1

N2 - Background: Second-generation antipsychotics have largely replaced first-generation antipsychotics for the treatment of schizophrenia, but a large-scale cost/effectiveness analysis has not been attempted. Method: Patients with schizophrenia (N=1,493) were assigned to treatment with a first-generation antipsychotic (perphenazine) or one of four second-generation drugs (olanzapine, quetiapine, risperidone, or ziprasidone) and followed for up to 18 months. Patients with tardive dyskinesia were prohibited from assignment to perphenazine. Patients could be reassigned at any time to another second-generation drug, including clozapine, but not to perphenazine. The cost analysis included medications plus health services use. Quality-adjusted life year (QALY) ratings were assessed on the basis of Positive and Negative Syndrome Scale (PANSS) subscale scores and side effects. An intention-to-treat analysis included all available observations, classified by initial drug assignment, and costs of reassignment of most patients to another second-generation drug. The analysis was repeated considering only treatment on initially assigned medications. Results: Although QALY ratings, PANSS scores, and other quality of life measures indicated modest improvement over 18 months, there were no significant differences between perphenazine and any second-generation medication. Average total monthly health care costs were $300-$600 (20%-30%) lower for perphenazine than for second-generation antipsychotics because of lower drug cost. Differences in costs remained when maximally discounted drug prices were used for all patients and when only observations during treatment with the first medication were included. Conclusions: Treatment with perphenazine was less costly than treatment with second-generation antipsychotics with no significant differences in measures of effectiveness. However, the trial was limited by a high dropout rate, and longer-term neurological and metabolic side effects require further study.

AB - Background: Second-generation antipsychotics have largely replaced first-generation antipsychotics for the treatment of schizophrenia, but a large-scale cost/effectiveness analysis has not been attempted. Method: Patients with schizophrenia (N=1,493) were assigned to treatment with a first-generation antipsychotic (perphenazine) or one of four second-generation drugs (olanzapine, quetiapine, risperidone, or ziprasidone) and followed for up to 18 months. Patients with tardive dyskinesia were prohibited from assignment to perphenazine. Patients could be reassigned at any time to another second-generation drug, including clozapine, but not to perphenazine. The cost analysis included medications plus health services use. Quality-adjusted life year (QALY) ratings were assessed on the basis of Positive and Negative Syndrome Scale (PANSS) subscale scores and side effects. An intention-to-treat analysis included all available observations, classified by initial drug assignment, and costs of reassignment of most patients to another second-generation drug. The analysis was repeated considering only treatment on initially assigned medications. Results: Although QALY ratings, PANSS scores, and other quality of life measures indicated modest improvement over 18 months, there were no significant differences between perphenazine and any second-generation medication. Average total monthly health care costs were $300-$600 (20%-30%) lower for perphenazine than for second-generation antipsychotics because of lower drug cost. Differences in costs remained when maximally discounted drug prices were used for all patients and when only observations during treatment with the first medication were included. Conclusions: Treatment with perphenazine was less costly than treatment with second-generation antipsychotics with no significant differences in measures of effectiveness. However, the trial was limited by a high dropout rate, and longer-term neurological and metabolic side effects require further study.

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