CLINICAL HANDBOOK OF SCHIZOPHRENIA

48. The Economics of Schizophrenia 511tiveness analyses of interventions allow consumers to compare their efficiency (ability toachieve effects at the least cost) whenever financial resources are limited. Cost-effectiveinterventions do not necessarily mean cost savings. Expensive technologies that have largebenefits may increase overall costs of treatment but be more effective, and more cost-effective.Pharmacological TreatmentEvidence of the cost-effectiveness of pharmacological interventions is only recentlyemerging and for the most part is still contradictory. Research in the United States has focusedmostly on the relative cost-effectiveness of newer antipsychotics, such as clozapine,risperidone, olanzapine, and quetiapine, compared to haloperidol, a popular traditionalantipsychotic. Pharmacological cost-effectiveness studies need to be viewed with caution,because they often omit important components of costs such as the side effects of medications,or societal benefits such as reduced encounters with the criminal justice systemafter switching to atypical antipsychotics.ClozapineClozapine appears to be the most cost-effective antipsychotic drug compared to bothatypical and typical antipsychotics. It is the most cost-effective medication used amongtreatment-resistant patients and has proven clinical benefits, resulting in reduced hospitalizationand a shift to outpatient treatment. Clozapine is also associated with fewer relapsesand higher patient satisfaction, although its effect on global/social functioning isambiguous. The benefits of clozapine seem to offset its higher acquisition costs comparedto typical antipsychotics. However, use of clozapine has been limited because of rare butpotentially lethal side effects.New Atypical versus Traditional AntipsychoticsThere is still a lack of consensus about whether new atypical antipsychotics are costeffectivecompared to traditional antipsychotics. Acquisition prices of atypical antipsychoticsare much higher than those for typical antipsychotics. For example, the federallynegotiated price for a 30-day supply of olanzapine or risperidone exceeds $400, whereasa 30-day supply of haloperidol may cost as little as $20. This difference in prices makes acase against the use of atypical antipsychotics from an economic point of view, unlessthey have a clear clinical advantage. Some studies suggest that risperidone, olanzapine,and quetiapine enjoy greater acceptance by patients and can offset higher acquisitioncosts by improving clinical outcomes. However, as mentioned, most studies typically havenot included side effects and indirect benefits in their calculations. Furthermore, the majorityof trials comparing new atypical antipsychotics to haloperidol may be biased,because patients taking haloperidol in these trials were not given prophylactic medicationsthat would alleviate side effects (Rosenheck, 2005).Cost-Effectiveness of New AntipsychoticsThe comparative value of atypical antipsychotics is still unclear. Each drug has a differentside effect profile, which makes it difficult to assess cost-effectiveness. Research in thisarea is contradictory and should be viewed with caution. The net effect of years of researchcan probably be summarized by the findings of a recent study published in theNew England Journal of Medicine, suggesting that olanzapine has the advantage of lower