Cost Benefits of New Schizophrenia Drugs Doubted

So sayeth the Washington Post.

"Treating schizophrenia with an older, cheaper drug, rather than with heavily promoted newer medications, reduces the cost by as much as 30 percent with no apparent difference in safety and effectiveness, according to the first study to examine the economic implications of antipsychotic drug prescribing practices in the United States."

A recent study in the American Journal of Psychiatry found that perphenazine was notably less expensive than atypical antipsychotics.

"Earlier research had shown that the older drug was as safe and effective as the newer medications. But experts cautioned against assuming that the cheaper drug would be as cost-effective once hospitalizations, side effects and quality-of-life issues were taken into account.

The new study, published today in the American Journal of Psychiatry, concluded that when those factors were included, monthly costs per patient were $300 to $600 lower with the drug perphenazine, which is no longer under patent."

--SNIP--

"In an indication of the widespread unease in the psychiatric establishment over the results, one senior doctor who helped conduct the study but not the cost-effectiveness assessment said the new finding faced stiff headwinds before it was published, and was subjected to an extraordinary level of review.

"You are saying perphenazine is $500 cheaper," said the doctor, who spoke on condition of anonymity because of the sensitivity of the issue , to explain why many psychiatrists weighing the study seemed aghast. "Now the physicians feel defensive, because people will ask, 'Why are you charging the patient and insurance company $500 more when the drugs don't give you anything more?' "

I'll join many others, including the study authors, who have stated that this doesn't mean everyone should switch from atypical antipsychotics to older antipsychotic meds. Treatment should of course be flexible and vary by patient response. But this along with a slew of other findings (like this, this, this, and this) indicate rather clearly that the medication algorithm should not necessarily start with prescribing an atypical antipsychotic medication. If we know one set of drugs is generally as safe (or in this case, as unsafe), as effective, and much less expensive than another class of drugs, the implications should be pretty clear, right?

I hope to hear more about the extraordinary review process to which this article was subjected. Of course, had the results favored the newer meds, there would have been standard or minimal review.