Intramuscular haloperidol versus intramuscular olanzapine for treatment of acute agitation: a cost-minimization study.
OBJECTIVE
To investigate prescribing patterns for antipsychotic regimens based on intramuscular haloperidol or intramuscular olanzapine for treating acute agitation; to compare the costs of each drug regimen, which included adjunctive anxiolytics and/or anticholinergics; and to compare the effectiveness and safety of each drug regimen.


METHODS
Retrospective medical record review.


METHODS
State psychiatric facility.


METHODS
Twenty-seven patients who received intramuscular haloperidol to treat 47 episodes of acute agitation and 26 patients who received intramuscular olanzapine to treat 38 episodes.


RESULTS
Data from patients receiving the antipsychotic regimens between August 2004 and March 2007 were reviewed. Mean +/- SD doses were 6.4 +/- 2.4 mg (range 2.5-10 mg) for haloperidol and 8.1 +/- 2.3 mg (range 5-10 mg) for olanzapine. The mean +/- SD cost of treating an episode of agitation with haloperidol was significantly lower at $4.06 +/- 3.98 (range $1.74-18.35) versus $27.84 +/- 10.40 (range $21.58-52.46) for olanzapine (p<0.0001). Significantly fewer patients who received haloperidol than patients who received olanzapine required additional pharmacotherapy to manage agitation (41% vs 69%, chi(2)=4.34, p=0.04). No significant differences were found between groups in the mean number of repeat doses of psychotropic drugs needed/episode (0.6 [range 0-5] for haloperidol vs 0.8 [range 0-3] for olanzapine, p=0.47), in the percentages of patients who required seclusion and/or restraints (59% for haloperidol vs 58% for olanzapine, chi(2)=0.01, p=0.91), or in time spent in seclusion and/or restraints (3.7 +/- 7.1 for haloperidol vs 3.6 +/- 6.5 hrs for olanzapine, p=0.92). No adverse events were documented with either drug.


CONCLUSIONS
For the treatment of acute episodes of agitation, regimens based on intramuscular haloperidol were significantly less expensive than and at least as effective as those based on intramuscular olanzapine.
Freeman
Darren J
DJ
School of Pharmacy, University of Maryland, Baltimore, Maryland, USA.
DiPaula
Bethany A
BA
Love
Raymond C
RC
D000208:Acute Disease; D000328:Adult; D014151:Anti-Anxiety Agents / Q000191:economics; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics*; D001569:Benzodiazepines / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics*; D018680:Cholinergic Antagonists / Q000191:economics; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D016527:Drug Costs; D005260:Female; D006220:Haloperidol / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics*; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D000077152:Olanzapine; D010356:Patient Isolation / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D011595:Psychomotor Agitation / Q000188:drug therapy / Q000191:economics* / Q000628:therapy; D012149:Restraint, Physical / Q000706:statistics & numerical data; D013997:Time Factors
D014151:Anti-Anxiety Agents; D014150:Antipsychotic Agents; D018680:Cholinergic Antagonists; D001569:Benzodiazepines; D006220:Haloperidol; D000077152:Olanzapine