Schizophrenia treatment with older, generic antipsychotics cheaper, as effective as treatment with newer drugs

Treating schizophrenia patients with older, less expensive antipsychotic drugs reduces overall treatment costs by up to 30% and produces no increase in side effects or decrease in effectiveness compared with newer, brand-name medications, according to a cost-effectiveness study published Friday in the American Journal of Psychiatry, the Washington Post reports.

The study provides the latest results from the Clinical Antipsychotic Trials in Interventions Effectiveness, a National Institute of Mental Health study on the treatment of schizophrenia (Vedantam, Washington Post, 12/1). For the new study, lead author Robert Rosenheck and colleagues from Yale Medical School compared overall treatment costs -- including the cost of hospitalizations -- of the older generic drug perphenazine with four newer, brand-name treatments. The study found that the average monthly cost of treatment with perphenazine was $960, including the $50 cost of the medication. In comparison, the average monthly cost of treatment with the Eli Lilly drug Zyprexa was $1,404, including $545 for the medication, and the average monthly cost for the Johnson & Johnson treatment Risperdal was $1,533, including $474 for the medication, the study found. The study also found that participants who took perphenazine had a higher quality of life over 18 months than those on the other drugs, although that result was not statistically significant. Last year, separate findings from the CATIE study found that perphenazine was equally effective in treating schizophrenia as the newer drugs (Johnson, Wall Street Journal, 12/1). According to the Post, the new analysis is the "first study to look at the economic implications of antipsychotic drug prescribing practices in the U.S."

Comments
The study's authors and several psychiatric experts, including NIMH Director Thomas Insel, said the study does not indicate that patients who are doing well on the newer drugs should be switched to older medications, because patients who have found a beneficial treatment regimen should remain on it. However, because many patients with schizophrenia often need to change drugs, "many could become candidates for treatment with the less expensive drug," according to the Post. In an editorial accompanying the study, Robert Freedman, editor in chief of AJP, noted that research has found that the newer medications have different, but not fewer, side effects than the older drug. Freedman said, "If [patients] are chronically ill and are not on medication or want to switch, it is certainly a rational choice and would save money, and for the most part we can't detect effectiveness differences." Rosenheck said the study "triples the size of the antipsychotic armamentarium available to psychiatrists." He added, "Before CATIE, we had five to six drugs and we had tremendous pressure to not use the other 15. What CATIE has said is doctors should feel free to use whatever medicine is right for their patient, and there are 19 or 20 choices, not five or six."

Concerns
Freedman and other psychiatry experts expressed concern that the study would lead insurers to limit access to the more expensive drugs. Jerry Avorn, a professor of medicine at Harvard Medical School, said, "The resistance to this kind of finding comes from ... the very legitimate worry that boneheaded cost containers will read this study and then try to get every schizophrenic on every other medication to be switched to the cheapest available product" (Washington Post, 12/1). A CMS spokesperson said federal insurance programs cover all the different drugs. A J&J spokesperson said the dropout rate in the study was a concern (Wall Street Journal, 12/1). Eli Lilly and AstraZeneca, maker of the antipsychotic Seroquel, in statements said patients benefit from individualized treatment (Washington Post, 12/1).