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Schizophrenia Bulletin 2003 29(1):81-93;
© 2003 by Oxford University Press and the Maryland Psychiatric Research Center (MPRC)
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© Oxford University Press

Changing Environments and Alternative Perspectives in Evaluating the Cost-Effectiveness of New Antipsychotic Drugs

Robert Rosenheck, M.D., Jefferson Doyle, M.P.H., Douglas Leslie, Ph.D. and Alan Fontana, Ph.D.
Director, VA Northeast Program Evaluation Center, and Professor of Psychiatry and Public Health, Yale Medical School New Haven, CT
student, Oxford University Medical School Oxford, U.K.
Health Economist, VA Northeast Program Evaluation Center, and Assistant Professor of Psychiatry and Public Health, Yale Medical School
Director, Post Traumatic Stress Disorder Evaluation, Northeast Program Evaluation Center, and Associate Research Scientist, Department of Psychiatry, Yale University

Send reprint requests to Dr. R. Rosenheck, Northeast Program Evaluation Center, VA Connecticut Healthcare System, 950 Cambell Ave., West Haven, CT 06516; e-mail: Robert.Rosenheck{at}Yale.Edu

This article examines the ways in which changes in the treatment environment and in measurement perspectives can affect the evaluation of cost-effectiveness of new medications. In three studies we reexamined data from a clinical trial of haloperidol and clozapine conducted from 1993 to 1996. The results of the studies are as follows:

Study 1 found that clozapine treatment was associated with significantly reduced inpatient costs, and increased outpatient costs, suggesting that as systems use less inpatient care and more outpatient care, more effective medications may increase, rather than decrease, costs in sicker patients.

Study 2 found that while provider assessments and standard measures favored clozapine over haloperidol, patient responses showed little evidence of a clinical advantage for clozapine and a less favorable side-effect profile.

Study 3 found that while annual drug costs in the published trial were estimated to be $4,545 for a full year of clozapine treatment, atypical antipsychotic costs in 2000 were estimated to range from $1,254 to $3,016 in the Department of Veterans Affairs system, and from $2,221 to $8,147 in the private sector.

In conclusion, cost-effectiveness, as evaluated in studies like CATIE, will increasingly need to be tied to service system contingencies, environments, and evaluation perspectives.

Keywords: Schizophrenia / cost-effectiveness / psychopharmacology / veterans / randomized controlled trials


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