Influence of antipsychotic profile on cost of treatment of schizophrenia: A decision analysis approach

Schizophrenia affects around 1% of the population but accounts for a much larger proportion of healthcare costs. New atypical antipsychotics are perceived as expensive because of higher drug costs, even though such drug costs account for only a small percentage of the total cost of care. However, if these agents reduce other types of treatment costs they could prove to be highly cost-effective. This paper presents a health economic model for the treatment of an acute episode of chronic schizophrenia and its subsequent control through maintenance treatment. Simulation experiments, using cost data reported for England, indicate that the most important treatment cost is care setting: treatments enabling patients to move from expensive inpatient and sheltered accommodation to less expensive settings represent the largest potential cost saving. Atypical antipsychotics with improved efficacy in negative symptoms and/or cognitive function may facilitate this and thus lead to substantial savings. Enhanced efficacy in positive symptoms, and improvements in compliance and relapse rates also have an influence on the cost of treating schizophrenia. Model predictions suggest that reported clinical profiles of atypical antipsychotics could lead to significant savings and large improvements in effectiveness over conventional therapy. Prospective studies are required to confirm these findings.