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Cost-effectiveness of first- v. second-generation antipsychotic drugs: results from a randomised controlled trial in schizophrenia responding poorly to previous therapy

University of Manchester

P. B. Jones, MD, PhD

University of Cambridge

T. R. E. Barnes, MD, DSc

Imperial College, London

F. Gaughran, MD

Institute of Psychiatry, London

K. Hayhurst, MSc and A. Markwick, BA

University of Manchester

H. Lloyd, MSc

Imperial College, London, UK

the CUtLASS team

Correspondence: Linda Davies, Division of Psychiatry, University of Manchester, Rawnsley Building, MRI, Oxford Road, Manchester M13 9WL, UK. Tel: +44 (0) 161 276 5380; email: Linda.davies{at}manchester.ac.uk

Declaration of interest Funding from the Secretary of State for Health (UK). The authors have received consultancy fees, honoraria or departmental support from the pharmaceutical industry, including Novartis, BMS Otsuka, Janssen Cilag, Servier, BMS, Astra-Zeneca, Sanofi-Synthelabo, Eli Lilly and Johnson & Johnson. F.G. is related to an employee of Eli Lilly & Co.

Background There are claims that the extra costs of atypical (second-generation) antipsychotic drugs over conventional (first-generation) drugs are offset by improved health-related quality of life.

Aims To determine the relative costs and value of treatment with conventional or atypical antipsychotics in people with schizophrenia.

Method Cost-effectiveness acceptability analysis integrated clinical and economic randomised controlled trial data of conventional and atypical antipsychotics in routine practice.

Results Conventional antipsychotics had lower costs and higher quality-adjusted life-years (QALYs) than atypical antipsychotics and were more than 50% likely to be cost-effective.

Conclusions The primary and sensitivity analyses indicated that conventional antipsychotics may be cost-saving and associated with a gain in QALYs compared with atypical antipsychotics.

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