The treatment of challenging behaviour in intellectual disabilities: cost-effectiveness analysis.
BACKGROUND
Antipsychotic drugs are used in the routine treatment of adults with intellectual disabilities (ID) and challenging behaviour in the UK despite limited evidence of their effectiveness. There is no evidence on their cost-effectiveness.


METHODS
The relative cost-effectiveness of risperidone, haloperidol and placebo in treating individuals with an ID and challenging behaviour was compared from a societal perspective in a 26-week, double-blind, randomised controlled trial. Outcomes were changes in aggression and quality of life. Costs measured all service impacts and unpaid caregiver inputs.


RESULTS
After 26 weeks, patients randomised to placebo had lower costs compared with those in the risperidone and haloperidol treatment groups. Aggression was highest for patients treated with risperidone and lowest for patients treated with haloperidol; however, quality of life was lowest for patients treated with haloperidol and highest for patients treated with risperidone.


CONCLUSIONS
The treatment of challenging behaviour in ID with antipsychotic drugs is not a cost-effective option.
Romeo
R
R
Centre for the Economics of Mental Health, King's College London, Institute of Psychiatry, London, UK. r.romeo@iop.kcl.ac.uk
Knapp
M
M
Tyrer
P
P
Crawford
M
M
Oliver-Africano
P
P
D000328:Adult; D000374:Aggression / Q000187:drug effects / Q000523:psychology; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D003131:Combined Modality Therapy / Q000191:economics; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D004311:Double-Blind Method; D016527:Drug Costs / Q000706:statistics & numerical data*; D004739:England; D005260:Female; D005500:Follow-Up Studies; D006220:Haloperidol / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D006801:Humans; D008607:Intellectual Disability / Q000188:drug therapy* / Q000191:economics* / Q000523:psychology; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy* / Q000191:economics* / Q000523:psychology; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology; D018967:Risperidone / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D014852:Wales
D014150:Antipsychotic Agents; D006220:Haloperidol; D018967:Risperidone