Cost and cost-effectiveness in a randomized trial of long-acting risperidone for schizophrenia.
OBJECTIVE
The effect of long-acting injectable (LAI) risperidone on health care costs was determined in a multisite clinical trial.


METHODS
Veterans Health Administration patients with unstable schizophrenia or schizoaffective disorder established by the Structured Clinical Interview for DSM-IV (N = 369) were randomized between 2006 and 2009 to long-acting risperidone or physician's choice of oral antipsychotic. Health care utilization and cost were tracked in administrative data. Medication administered by the trial was recorded on case report forms. Medication cost was based on unit costs to the US Medicaid program. Economic outcomes were assessed with the Quality of Well-Being instrument.


RESULTS
Participants randomized to LAI risperidone (n = 187) incurred $14,916 per quarter in total health care costs, which was not significantly different from the $13,980 cost incurred by the control group (P = .732) (n = 182). The LAI group incurred $3,028 per quarter in medication cost, significantly more than the $1,913 incurred by the control group (P = .003). Hospitalization costs were $7,088 in the experimental group and $6,891 in the control group (P = .943); outpatient costs were $11,888 in the experimental group and $12,067 in the control group (P = .639). LAI risperidone did not result in better outcomes as evaluated by a measure of schizophrenia symptoms or an assessment of health related quality of life and incurred more adverse events.


CONCLUSIONS
Patients with unstable schizophrenia were randomized in a practical trial of LAI risperidone. This antipsychotic significantly increased medication costs but did not reduce hospital or total health care cost or improve outcomes and was thus not cost-effective.


BACKGROUND
ClinicalTrials.gov identifier: NCT00132314.
Health Economics Resource Center, VA Cooperative Studies Program, VA Palo Alto Health Care System, Menlo Park, CA 94025, USA. paul.barnett@va.gov
Paul G
PG
Barnett
Jennifer Y
JY
Scott
John H
JH
Krystal
Robert A
RA
Rosenheck
D014150:Antipsychotic Agents / Q000191:economics* / Q000627:therapeutic use; D057186:Comparative Effectiveness Research; D003362:Cost-Benefit Analysis; D003692:Delayed-Action Preparations; D004311:Double-Blind Method; D016527:Drug Costs; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007267:Injections; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D011618:Psychotic Disorders / Q000188:drug therapy*; D018967:Risperidone / Q000191:economics* / Q000627:therapeutic use; D012559:Schizophrenia / Q000188:drug therapy*; D014481:United States; D014728:Veterans
D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations; D018967:Risperidone