R A Rosenheck1. 1. Yale Department of Psychiatry, New Haven, CT, USA. Robert.Rosenheck@Yale.Edu
Abstract
BACKGROUND: Second-generation antipsychotics may have few advantages over older, cheaper drugs, except for possibly reduced risk of tardive dyskinesia. AIMS: To evaluate the cost-effectiveness of second-generation antipsychotics with regard to reducing tardive dyskinesia. METHOD: Literature was reviewed on risk of tardive dyskinesia with second-generation antipsychotics; on severity, duration and impairment of tardive dyskinesia; and on the relationship of this disorder to quality of life and quality-adjusted life-years (QALYs). Diverse cost and benefit assumptions and of 1-year and 5-year planning horizons were examined in a deterministic sensitivity analysis. RESULTS: Estimating 0.143 QALYs lost per case of severe tardive dyskinesia, 1-year cost-effectiveness cumulative estimates ranged from pounds 74,000 (dollars 149,000) to pounds 342,000 (dollars 683,000) per QALY, all above the conventional policy threshold of pounds 25,000 (dollars 50,000). CONCLUSIONS: Reduction of tardive dyskinesia with second-generation antipsychotics appears unlikely to meet standards for cost-effectiveness.
BACKGROUND: Second-generation antipsychotics may have few advantages over older, cheaper drugs, except for possibly reduced risk of tardive dyskinesia. AIMS: To evaluate the cost-effectiveness of second-generation antipsychotics with regard to reducing tardive dyskinesia. METHOD: Literature was reviewed on risk of tardive dyskinesia with second-generation antipsychotics; on severity, duration and impairment of tardive dyskinesia; and on the relationship of this disorder to quality of life and quality-adjusted life-years (QALYs). Diverse cost and benefit assumptions and of 1-year and 5-year planning horizons were examined in a deterministic sensitivity analysis. RESULTS: Estimating 0.143 QALYs lost per case of severe tardive dyskinesia, 1-year cost-effectiveness cumulative estimates ranged from pounds 74,000 (dollars 149,000) to pounds 342,000 (dollars 683,000) per QALY, all above the conventional policy threshold of pounds 25,000 (dollars 50,000). CONCLUSIONS: Reduction of tardive dyskinesia with second-generation antipsychotics appears unlikely to meet standards for cost-effectiveness.
Authors: Stanley N Caroff; Vicki G Davis; Del D Miller; Sonia M Davis; Robert A Rosenheck; Joseph P McEvoy; E Cabrina Campbell; Bruce L Saltz; Silvana Riggio; Miranda H Chakos; Marvin S Swartz; Richard S E Keefe; T Scott Stroup; Jeffrey A Lieberman Journal: J Clin Psychiatry Date: 2010-08-10 Impact factor: 4.384