Clinical and pharmacoeconomic evaluation of switch to olanzapine in veterans with schizophrenia or schizoaffective disorder.
BACKGROUND
Second-generation atypical antipsychotics improve the outcome of patients with schizophrenia, although studies of their cost efficacy in comparison to first-generation conventional antipsychotics have yielded mixed results.


OBJECTIVE
This study examines the cost effectiveness outcome of olanzapine treatment in veterans with schizophrenia (n 5 22) or schizoaffective disorder (n 5 4).


METHODS
Health-care utilization and costs associated with prospective olanzapine treatment were compared with those of retrospective first-generation neuroleptic treatment in a mirror-image design.


RESULTS
The analysis of variance with repeated measures for the Positive and Negative Syndrome Scale (PANSS; n 5 22) showed a significant main effect of olanzapine treatment (p , .025), and the effect was of medium-to-large size (h2 5 .13). The PANSS-positive subscale (p , .005) and the PANSS general subscale (p , .005) significantly decreased, but the PANSS negative subscale did not change. The quality of life survey (n 5 21) significantly increased (p , .025), and the effect size was large (h2 5 .14). For VA outpatient and inpatient care, study patients incurred an average cost difference of 2$1,289 (NS) and 2$6,682 (NS), respectively. Combining inpatient and outpatient VA care, patients incurred an annual difference of 2$7,971 per patient (NS). These numerically lower costs were due, in part, to a slower growth rate in outpatient encounters (p 5 .013), lower overall cost per outpatient encounter (p 5 .008), and a lower overall inpatient encounter rate (p 5 .005).


CONCLUSIONS
Olanzapine treatment resulted in improvements in positive and general psychiatric symptoms, as well as quality of life. Negative symptoms did not change significantly. Though not statistically significant, the postbaseline health-care costs and utilization declined.
Davis
Lori L
LL
University of Alabama School of Medicine, Birmingham, AL, USA. lori.davis@va.gov
Cates
Marshall E
ME
Lowe
Joette S
JS
Ward
L Charles
LC
Johnson
Jeffrey D
JD
Williford
Raela B
RB
Ambrose
Sandra M
SM
Thomas
Brandi L
BL
Kashner
Terrell Michael
TM
D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000191:economics / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D017850:Economics, Pharmaceutical; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077152:Olanzapine; D011618:Psychotic Disorders / Q000188:drug therapy*; D011788:Quality of Life; D012189:Retrospective Studies; D012559:Schizophrenia / Q000188:drug therapy*; D014728:Veterans
D014150:Antipsychotic Agents; D001569:Benzodiazepines; D000077152:Olanzapine