Cost-effectiveness analysis of pharmacological treatments in schizophrenia: critical review of results and methodological issues.
OBJECTIVE
To comprehensively review and critically appraise the results and the methodological issues in the cost-effectiveness literature on pharmacological treatments in schizophrenia.


METHODS
Relevant literature published in peer-reviewed journals was identified through a computer search in Medline from 1975 to 2002. Further studies were identified using reference lists and published review articles. Articles included in the review were required to evaluate both costs and clinical outcomes in the same study.


RESULTS
Seventeen articles met all inclusion criteria. Cost-effectiveness analysis (CEA) in schizophrenia spans three types of studies-randomized trial-based studies (six), retrospective cohort-based studies (six) and decision model-based studies (five). Comparing results from CEA across all types of studies in schizophrenia reveals a large ambiguity in the incremental evaluation of newer atypicals. For treatment-resistant patients, clozapine seems to produce cost saving and better outcomes compared to standard neuroleptics. However, there is tremendous uncertainty in the estimates of cost savings and clinical benefits that may prevent decision makers from making optimal policy decisions about insurance coverage and formulary design based on these results. For chronic schizophrenic patients, the results are even more ambiguous. For example, the studies based on trial settings find risperidone to cost more than haloperidol, while studies based on cohort design and decision models find risperidone to be either equivalent or lower in costs than haloperidol.


CONCLUSIONS
Further studies of cost-effectiveness need to be carried out with careful consideration of the limitations of published analyses. There are a variety of theoretical and methodological issues that are important to consider during the development of new decision models in this field.
Harris School of Public Policy Studies, University of Chicago, 1155 E. 60th Street, Chicago, IL 60637, USA. abasu@uchicago.edu
Anirban
A
Basu
D014150:Antipsychotic Agents / Q000191:economics* / Q000627:therapeutic use*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D006801:Humans; D018967:Risperidone / Q000191:economics* / Q000627:therapeutic use*; D012559:Schizophrenia / Q000188:drug therapy* / Q000191:economics*
D014150:Antipsychotic Agents; D018967:Risperidone