The British Journal of Psychiatry (2007) 191: 238-245. doi: 10.1192/bjp.bp.106.035063
© 2007 The Royal College of Psychiatrists
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Evaluating the cost-effectiveness of reduced tardive dyskinesia with second-generation antipsychotics

R. A. Rosenheck, MD

Yale Department of Psychiatry, New Haven, Connecticut, USA

Correspondence: Dr R. Rosenheck, Northeast Program Evaluation Center (182), VA Connecticut Health Care System, 950 Campbell Avenue, West Haven, CT 06516, USA. Tel: +1 203 937 3850; fax: +1 203 937 3433; e-mail: Robert.Rosenheck{at}Yale.Edu

Declaration of interest R.A.R. has received research support from and/or been a consultant to AstraZeneca, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Janssen Pharmaceutica and Wyeth.

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 riskof 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 estimates for second-generation antipsychotics ranged from £185 000 ($370 000) to £850 000 ($1.7 million) per QALY, and 5-year cumulative estimates ranged from £74 000 ($149 000) to £342 000 ($683 0000) per QALY, all above the conventional policy threshold of £25 000 ($50 000).

Conclusions Reduction of tardive dyskinesia with second-generation antipsychotics appears unlikely to meet standards for cost-effectiveness.


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Home page
 Psychiatr. Serv.Home page
R. A. Rosenheck, D. L. Leslie, and J. A. Doshi
Second-Generation Antipsychotics: Cost-Effectiveness, Policy Options, and Political Decision Making
Psychiatr Serv, May 1, 2008; 59(5): 515 - 520.
[Abstract] [Full Text] [PDF]