Principles of antipsychotic prescribing for policy makers, circa 2008. Translating knowledge to promote individualized treatment.
Findings from 2 pivotal government-funded studies of comparative antipsychotic effectiveness undermine assumptions about the marked superiority of the more expensive second-generation "atypical" medications in comparison to the less expensive first-generation "typical" drugs. Because this assumption was the basis for the almost universal recommendation that these newer antipsychotics be used preferentially resulting in a 10-fold increase in state governmental expenditures on this class of medications over the past decade, a reassessment of policy is called for. To address the issue, the Medical Directors Council of the National Association of State Mental Health Program Directors critically reviewed findings of these studies in the context of other data and considered policy implications in the light of the obligations of state government to make available best possible and individually optimized treatment that is cost-effective. The Medical Directors Council unanimously adopted a set of recommendations to promote appropriate access, efficient utilization, and best practice use. We present our policy statement, in which we provide a succinct background, articulate general principles, and describe a set of 4 broad recommendations. We then summarize our understanding of the current state of knowledge about comparative antipsychotic effectiveness, best antipsychotic practice, and considerations for state policy that represent the basis of our position statement.
Parks
Joseph
J
State of Missouri Department of Mental Health, USA.
Radke
Alan
A
Parker
George
G
Foti
May-Ellen
ME
Eilers
Robert
R
Diamond
Mary
M
Svendsen
Dale
D
Tandon
Rajiv
R
D014150:Antipsychotic Agents / Q000191:economics / Q000627:therapeutic use*; D019985:Benchmarking; D003362:Cost-Benefit Analysis; D016527:Drug Costs / Q000706:statistics & numerical data; D005380:Financing, Government / Q000191:economics; D005102:Health Expenditures / Q000706:statistics & numerical data; D006291:Health Policy / Q000191:economics; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D017410:Practice Guidelines as Topic; D011358:Product Surveillance, Postmarketing; D016032:Randomized Controlled Trials as Topic; D012559:Schizophrenia / Q000188:drug therapy* / Q000191:economics; D012565:Schizophrenic Psychology; D016896:Treatment Outcome; D014481:United States
D014150:Antipsychotic Agents