Wednesday, November 22, 2006

Atypical Antipsychotics vs. Older Meds: $$$

I have seen various estimates in the media that have generally capped out at a ten-fold increase in price for atypical antipsychotics compared to older meds. However, I'd seen figures a few years ago suggesting a much larger price gap, so I thought I'd do some digging.

Here's what I found on These are monthly costs.

Olanzapine (Zyprexa) 15mg: $554.98
Risperidone (Risperdal) 4mg: $331.09
Quetiapine (Seroquel) 500mg: $519.77
Aripiprazole (Abilify) 20mg: $518.99
Ziprasidone (Geodon) 100mg: $483.08

Compared to:
Haloperidol (Haldol) 5mg : $10.89
Perphenazine 16mg: $29.83

Looking like a lot more than a 10-fold difference in price, eh?

Now, let's add in benztropine to control for some of the side effects commonly seen on haloperidol or perphenazine.

Benztropine 2mg: $12.09

We get a total of Haldol + benztropine of $22.98 per month and perphenazine + benztropine of $41.92. Thus, the cheapest new AP (Risperdal) is eight times as pricey as perphenazine + benztropine. Most of the comparisons with Haldol suggest that the price difference, even including benztropine as an adjunctive medication, is at least 20-fold. With perphenazine + benztropine, the difference decreases to 10-13 times as expensive.

The doses I used were from gleaning doses that were used in clinical trials.

We know, however, that the atypical antipsychotics are not 10-20 times more effective than older meds; indeed, there is little reason to suspect they are much more effective at all in comparison to older meds, as can be seen here, here, here, and here.


Alone said...

Finally, someone doing the analysis of cost the correct way.

Let me just add one thing: in a world where the doctor isn't accountable to the cost, there's no reason to Rx two drugs (e.g. haldol + cogentin) when one (atypical) would do.

If doctors had to opreate within a pharmacy budget, then there would be.

But it's not all bad for Pharma. For example, is Seroquel more expensive than Haldol+cogentin+ ambien? (I don't know.) If not, then AZ may have a case in using Seroquel over the combo.

you see my point. Any discussion about the relative merits of one drug over another has to include efficacy, safety, and cost. Right now, doctors are only responsible for the first two.

CL Psych said...

Thanks for your comment. I did the calculations including Ambien. For 12.5 mg/day, Ambien runs $111.99/month. Thus, an Ambien/Cogentin/Haldol cocktail is still much less pricey than a single atypical med on a monthly basis. If you REALLY liked polypharmacy, you could throw in generic alprazolam and paroxetine to the mix and still come out cheaper than a single atypical. But in the real world, I bet many docs prescribe and atypical or two along with Effexor or Lexapro in combination with Xanax XR to blow costs absolutely through the roof. And when prescribing to people with schizophrenia, who cares? After all, it's just the taxpayer who foots the bill in most cases!

Kass said...

Forgive me for my stupidity, but why are the atypicals so expensive? Is it just the fact that they're newer? I don't understand what makes them different from the older antipsychotics. (Sorry I haven't done my homework on this...)

CL Psych said...

The atypicals are more expensive because they are currently under patent -- there are no generic atypicals. Starting some time this year, Risperdal will lose its patent and a generic formulation will be available shortly.

The older meds are all generic at this point and are hence much cheaper