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

Publication ,  Journal Article
Rosenheck, RA; Leslie, DL; Sindelar, J; Miller, EA; Lin, H; Stroup, TS; McEvoy, J; Davis, SM; Keefe, RSE; Swartz, M; Perkins, DO; Hsiao, JK ...
Published in: Am J Psychiatry
December 2006

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, quetia-pine, 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 dollars-600 dollars (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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Published In

Am J Psychiatry

DOI

ISSN

0002-953X

Publication Date

December 2006

Volume

163

Issue

12

Start / End Page

2080 / 2089

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Schizophrenic Psychology
  • Schizophrenia
  • Research Design
  • Quality-Adjusted Life Years
  • Psychiatry
  • Psychiatric Status Rating Scales
  • Perphenazine
  • Patient Dropouts
  • Middle Aged
 

Citation

APA
Chicago
ICMJE
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Rosenheck, R. A., Leslie, D. L., Sindelar, J., Miller, E. A., Lin, H., Stroup, T. S., … CATIE Study Investigators, . (2006). Cost-effectiveness of second-generation antipsychotics and perphenazine in a randomized trial of treatment for chronic schizophrenia. Am J Psychiatry, 163(12), 2080–2089. https://doi.org/10.1176/ajp.2006.163.12.2080
Rosenheck, Robert A., Douglas L. Leslie, Jody Sindelar, Edward A. Miller, Haiqun Lin, T Scott Stroup, Joseph McEvoy, et al. “Cost-effectiveness of second-generation antipsychotics and perphenazine in a randomized trial of treatment for chronic schizophrenia.Am J Psychiatry 163, no. 12 (December 2006): 2080–89. https://doi.org/10.1176/ajp.2006.163.12.2080.
Rosenheck RA, Leslie DL, Sindelar J, Miller EA, Lin H, Stroup TS, et al. Cost-effectiveness of second-generation antipsychotics and perphenazine in a randomized trial of treatment for chronic schizophrenia. Am J Psychiatry. 2006 Dec;163(12):2080–9.
Rosenheck, Robert A., et al. “Cost-effectiveness of second-generation antipsychotics and perphenazine in a randomized trial of treatment for chronic schizophrenia.Am J Psychiatry, vol. 163, no. 12, Dec. 2006, pp. 2080–89. Pubmed, doi:10.1176/ajp.2006.163.12.2080.
Rosenheck RA, Leslie DL, Sindelar J, Miller EA, Lin H, Stroup TS, McEvoy J, Davis SM, Keefe RSE, Swartz M, Perkins DO, Hsiao JK, Lieberman J, CATIE Study Investigators. Cost-effectiveness of second-generation antipsychotics and perphenazine in a randomized trial of treatment for chronic schizophrenia. Am J Psychiatry. 2006 Dec;163(12):2080–2089.
Journal cover image

Published In

Am J Psychiatry

DOI

ISSN

0002-953X

Publication Date

December 2006

Volume

163

Issue

12

Start / End Page

2080 / 2089

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Schizophrenic Psychology
  • Schizophrenia
  • Research Design
  • Quality-Adjusted Life Years
  • Psychiatry
  • Psychiatric Status Rating Scales
  • Perphenazine
  • Patient Dropouts
  • Middle Aged