Cost-effectiveness of atypical antipsychotic medications versus conventional medication.

For almost 50 years, typical antipsychotics were the mainstay of pharmacological treatment for schizophrenia. However, during the last decade, the widespread use of expensive atypical antipsychotic medications has led to a dramatic increase in the proportion of the direct costs of schizophrenia being allocated for medications. Although there is evidence that the atypical antipsychotic clozapine may lead to cost savings in patients with refractory schizophrenia, the cost-effectiveness of the other atypical antipsychotics remains in question. Therefore, long-term randomised, prospective cost-effectiveness studies that compared an atypical to a typical antipsychotic have been reviewed in this paper. There were serious methodological problems with all the studies. In general, those that were based on efficacy trials showed an advantage for atypicals, whereas those based on effectiveness studies found the opposite. It seems that, to the extent that studies mimic real world conditions, they fail to support the cost-effectiveness of the atypical antipsychotics.