title: Effectiveness and cost of atypical versus typical antipsychotic treatment in a nationwide cohort of patients with schizophrenia in Germany.
abstract: This study investigates the effectiveness and cost of typical versus atypical antipsychotics in a nationwide German cohort of patients with schizophrenia. The study sample consisted of patients insured with 4 sickness funds (n = 8,610) who were followed up for 12 months after hospital discharge with a diagnosis of schizophrenia in 2003. Multivariate regression models were fitted to assess the relationship between outcome variables (rehospitalization, bed-days, prescriptions against adverse effects, cost) and medication type, sex, age, and severity. Severity was assessed by prior bed-days due to schizophrenia during 2000 to 2002. Risk of rehospitalization did not differ between groups but within each group severity (P = 0.0003). Males (P = 0.0016) and patients younger than 35 years (P < 0.0001) had a higher risk of rehospitalization. Number of bed-days was lower for treatment with typicals compared with atypicals (P < 0.0001); furthermore, bed-days depended on severity of disease (P < 0.0001). Prescriptions of drugs against extrapyramidal symptoms, anxiety, and agitation were higher for patients treated with typicals (P < 0.0001 for each). Mean predicted treatment cost per year was € 6442 for atypicals versus € 4443 for typicals (P < 0.0001). This study does not support unconditional superiority of atypicals over typicals, neither in terms of effectiveness nor in terms of cost.
authors.affiliation: Hamburg Center for Health Economics, University of Hamburg, Hamburg, Germany. Tom.Stargardt@wiso.uni-hamburg.de
authors.forename: Tom
authors.initials: T
authors.lastname: Stargardt
authors.forename: Marc-Andreas
authors.initials: MA
authors.lastname: Edel
authors.forename: Andreas
authors.initials: A
authors.lastname: Ebert
authors.forename: Reinhard
authors.initials: R
authors.lastname: Busse
authors.forename: Georg
authors.initials: G
authors.lastname: Juckel
authors.forename: Christian A
authors.initials: CA
authors.lastname: Gericke
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data; D012044:Regression Analysis; D012189:Retrospective Studies; D012559:Schizophrenia / Q000188:drug therapy* / Q000191:economics; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents