Top

PharmacoEconomics

Published in:

01-07-2003 | Original Research Article

Olanzapine versus Risperidone in the Treatment of Schizophrenia

A Comparison of Costs among Texas Medicaid Recipients

Authors: Karen L. Rascati, Michael T. Johnsrud, M. Lynn Crismon, Dr Maureen J. Lage, Beth L. Barber

Published in: PharmacoEconomics | Issue 10/2003

Abstract

Objective: To examine both schizophrenia-related costs and total (schizophrenia plus non-schizophrenia) healthcare costs among Texas Medicaid recipients who had been diagnosed with a schizophrenic disorder and had been initiated on olanzapine or risperidone.

Methods: Cost data for services and prescription use were retrieved for 2885 patients with schizophrenia who were initiated on olanzapine or risperidone between 1 January 1997 and 31 August 1998. Each patient was followed for 1 year before and 1 year after initiation of therapy. Multivariate analysis was used to control for a wide range of factors (drug choice, patient demographics, pre-utilisation costs, region, health conditions, and treatment patterns) that may influence schizophrenia-related costs and total healthcare costs. Estimation was conducted via a two-stage instrumental variables model.

Results: The mean unadjusted total schizophrenia-related cost per patient per year during the observation period was $US4892, and the total unadjusted healthcare cost per patient was $US7101. Results revealed significant regional variation in schizophrenia-related and total healthcare costs. Significantly higher total healthcare costs were found for patients with other (nonpsychiatric) diagnoses, such as HIV and diabetes mellitus. Although, on average, patients taking olanzapine stayed on therapy longer than those taking risperidone (248.2 days vs 211.1 days; p < 0.0001), multivariate analysis revealed no significant difference in schizophrenia-related costs between patients who received olanzapine and risperidone ($US123 lower with olanzapine; p = 0.6439). However, patients who received olanzapine compared with risperidone had significantly lower total medical costs ($US693 lower with olanzapine; p = 0.0311).

Conclusion: This naturalistic study used data from a Texas Medicaid population to examine the schizophrenia-related costs and total healthcare costs for patients who received olanzapine versus risperidone. Multivariate analysis revealed no significant differences in schizophrenia-related costs for patients receiving olanzapine compared with risperidone, although total medical costs were significantly lower for patients initiated on olanzapine.

Keith SJ, Regier DA, Rae DS. Schizophrenic disorders. In: Robins LN, Regier DA, editors. Psychiatric disorders in America: the epidemiologic catchment area study. New York (NY): Free Press, 1991

Wyatt RJ, Henter I, Leary MC, et al. An economic evaluation of schizophrenia — 1991. Soc Psychiatry Psychiatr Epidemiol 1995 Aug; 30 (5): 196–205PubMed

Mailer HJ. Atypical neuroleptics: a new approach in the treatment of negative symptoms. Eur Arch Psychiatry Clin Neurosci 1999; 249 Suppl. 4: 99–107CrossRef

Miller AL, Chiles JA, Chiles JK, et al. The TMAP schizophrenia algorithms. J Clin Psychiatry 1999; 60: 649–57PubMedCrossRef

Ballas C. Effects of antipsychotics on the clinical and psychosocial behavior of patients with schizophrenia. Schizophr Res 1997; 28 (2–3): 247–55CrossRef

Naber D. Long-term phase of schizophrenia: impact of atypical agents. Int Clin Psychopharmacol 2000; 15 Suppl. 4: S11–4

Revicki DA. Cost effectiveness of the newer atypical antipsychotics: a review of the pharmacoeconomic research evidence. Curr Opin Investig Drugs 2001; 2 (1): 110–7PubMed

Worrel JA, Marken PA, Beckman SE, et al. Atypical antipsychotic agents: a critical review. Am J Health Syst Pharm 2000 Feb 1; 57 (3): 238–55PubMed

Knapp M, Kavanagh S. Economic outcomes and costs in the treatment of schizophrenia. Clin Ther 1997; 19 (1): 128–38PubMedCrossRef

10.

Almond S, O’Donnell O. Cost analysis of the treatment of schizophrenia in the UK: a comparison of olanzapine and haloperidol. Pharmacoeconomics 1998; 13 (5 Pt 2): 575–88PubMedCrossRef

11.

Mauskopf JA, David K, Grainger DL, et al. Annual health outcomes and treatment costs for schizophrenia populations. J Clin Psychol 1999; 60 Suppl. 19: 14–19; 20–2

12.

Bhana N, Foster RH, Olney R, et al. Olanzapine: an update review of its use in the management of schizophrenia. Drugs 2001; 61 (1): 111–61PubMedCrossRef

13.

Kelly DL, Nelson MW, Love RC, et al. Comparison of discharge rates and drug costs for patients with schizophrenia treated with risperidone or olanzapine. Psychiatr Serv 2001 May; 52 (5): 676–8PubMedCrossRef

14.

Rabinowitz J, Lichtenberg P, Kaplan Z. Comparison of cost, dosage and clinical preference for risperidone and olanzapine. Schizophr Res 2000 Dec 15; 46 (2–3): 91–6CrossRef

15.

Procyshyn RM, Zerjav S. Drug utilization patterns and outcomes associated with in-hospital treatment with risperidone or olanzapine. Clin Ther 1998; 20 (6): 1203–17PubMedCrossRef

16.

Kasper S, Jones M, Duchesne I, et al. Risperidone olanzapine drug outcomes studies in schizophrenia (RODOS): health economic results of an international naturalistic study. Int Clin Psychopharmacol 2001 Jul; 16 (4): 189–96PubMedCrossRef

17.

Edgell ET, Andersen SW, Johnstone BM, et al. Olanzapine versus risperidone: a prospective comparison of clinical and economic outcomes in schizophrenia. Pharmacoeconomics 2000 Dec; 18 (6: 567–79PubMedCrossRef

18.

Foster RH, Goa KL. Olanzapine. A pharmacoeconomic review of its use in schizophrenia. Pharmacoeconomics 1999 Jun; 15 (6): 611–40PubMedCrossRef

19.

Lewis M, McCrone P, Frangou S. Service use and costs of treating schizophrenia with atypical antipsychotics. J Clin Psychiatry 2001 Oct; 62 (10): 749–56PubMedCrossRef

20.

Palmer CS, Revicki DA, Genduso LA, et al. A cost-effectiveness clinical decision analysis model for schizophrenia. Am J Manag Care 1998 Mar; 4 (3): 345–55PubMed

21.

Newhouse JP, McClellan M. Econometrics in outcomes research: the use of instrumental variables. Annu Rev Public Health 1998; 19: 17–34PubMedCrossRef

22.

D’Agostino RB, Kwan H. Measuring effectiveness: what to expect without a randomized control group. Med Care 1999; 33 (4): AS95–105

23.

Bureau of Managed Care: expansion of Medicaid Managed Care in Texas. Texas Department of Health. Available at URL: http://www.tdh.state.tx.us/hef/menew.html [Accessed 2002 April 9]

24.

Wolfgang AP. Introduction to health care delivery: a primer for pharmacists. In: Medicaid. McCarthy RL, editor. Gaithersburg (MA): Aspen Publishers, 2001

25.

Lurie N, Popkin M, Dysken M, et al. Accuracy of diagnoses of schizophrenia in Medicaid claims. Hosp Community Psychiatry 1992; 43: 69–71PubMed

26.

McClellan M, McNeil BJ, Newhouse JP. Does more intensive treatment of acute myocardial infarction in the elderly reduce mortality? Analysis using instrumental variables. JAMA 1994; 272: 850–66CrossRef

27.

Greene WH. Econometric analysis. Upper Saddle River (NJ): Prentice-Hall, 1997

28.

Hadley J, Ravin D, Epstein A, et al. Post-hospitalization home health care use and changes in functional status in a Medicare population. Med Care 2000; 39 (5): 494–507CrossRef

29.

Greene WH. LIMDEP: Version 7.0 user’s manual. Plainview (NY): Econometric Software, 1998

30.

Dixon L, Weiden P, Delahanty J, et al. Prevalence and correlates of diabetes in national schizophrenia samples. Schizophr Bull 2000; 26: 903–12PubMedCrossRef

31.

Zavoina R, McElvey W. A statistical model for the analysis of ordinal level dependent variables. J Math Sociology 1975; 13: 103–20

32.

Ramanathan R. Introductory econometrics with applications. Fort Worth (TX): The Dryden Press, 1998

33.

Lee LF. Generalized models with selectivity. Econometrica 1983; 51: 507–12CrossRef

34.

Nightengale BS, Crumly JM, Liao J, et al. Economic outcomes of antipsychotic agents in a Medicaid population: traditional agents vs. risperidone Psychopharmacol Bull 1998; 34 (3): 373–82PubMed

35.

Kaiser Family Foundation state health facts online. Available at URL: http://www.statehealthfacts.kff.org [Accessed 2003 May 15]

36.

Pharmaceutical Research and Manufacturers of America — publications — backgrounds and facts. Available at URL: http://www.phrma.org/publicationsibackgrounders/texas.phtml [Accessed 2002 April 9]

37.

Zhao Z. A retrospective economic evaluation of olanzapine versus risperidone in the treatment of schizophrenia [poster presentation]. New Orleans: American Psychiatric Association, 2001 May

38.

Guadagnoli E, Landrum MB, Normand SL, et al. Impact of underuse, overuse, and discretionary use on geographic variation in the coronary angiography after acute myocardial infarction. Med Care 2001 May; 39 (5): 446–58PubMedCrossRef

39.

Krumholz HM, Radford MJ, Wang Y, et al. National use and effectiveness of beta-blockers for the treatment of elderly patients after acute myocardial infarction: National Cooperative Cardiovascular Project. JAMA 1998 Aug 19; 280 (7): 623–9PubMedCrossRef

40.

Ginsberg G, Lerner Y, Mark M, et al. Prior hospitalization and age as predictors of mental health resource utilization in Israel. Soc Sci Med 1997 Mar; 44 (5): 623–33PubMedCrossRef

41.

Dixon L, Lyles A, Smith C, et al. Use and costs of ambulatory care services among Medicare enrollees with schizophrenia. Psychiatr Serv 2001; 52: 786–92PubMedCrossRef

42.

Heil H, Isomets ET, Henriksson MM, et al. Suicide victims with schizophrenia in different treatment phases and adequacy of antipsychotic medication. J Clin Psych 1999; 60 (3): 200–8CrossRef

43.

Olfson M, Mechanic D, Hansell S, et al. Predicting medication noncompliance after hospital discharge among patients with schizophrenia. Psychiatr Ser 2000 Feb; 51 (2): 216–22CrossRef

44.

Duncan JC, Rogers R. Medication compliance in patients with chronic schizophrenia: implications from community management of mentally disordered offenders. J Forensic Sci 1998 Nov; 43 (6): 1133–8PubMed

45.

Weiden PJ, Olfson M. Cost of relapse in schizophrenia. Schizophr Bull 1995; 1 (3): 419–29CrossRef

46.

Krystal JH, D’Souza DC, Madonick S, et al. Toward a rational pharmacotherapy of comorbid substance abuse in schizophrenic patients. Schizophr Res 1999 Mar 1; 35 Suppl.: S35–49

47.

Hoff RA, Rosenheck RA. The cost of treating substance abuse patients with and without comorbid psychiatric disorders. Psychiatr Serv 1999 Oct; 50 (10): 1309–15PubMed

48.

Tran PV, Hamilton SH, Kuntz AJ, et al. Double-blind comparison of olanzapine versus risperidone in the treatment of schizophrenia and other psychotic disorders. J Clin Psychopharmacology 1997; 17 (5): 407–18CrossRef

49.

Conley RR, Mahmoud R. A randomized double-blind study of risperidone and olanzapine in the treatment of schizophrenia or schizoaffective disorder. Am J Psychiatry 2001 May; 158 (5): 765–74PubMedCrossRef

50.

Ho BC, Miller D, Nopoulos P, et al. A comparative effectiveness study of risperidone and olanzapine in the treatment of schizophrenia. J Clin Psychiatry 1999; 60: 658–63PubMedCrossRef

51.

Zhao Z. A retrospective economic evaluation of olanzapine versus risperidone in the treatment of schizophrenia. Manag Care Interface 2002 Feb; 15 (2): 75–81PubMed

Title: Olanzapine versus Risperidone in the Treatment of Schizophrenia
A Comparison of Costs among Texas Medicaid Recipients
Authors: Karen L. Rascati
Michael T. Johnsrud
M. Lynn Crismon
Dr Maureen J. Lage
Beth L. Barber
Publication date: 01-07-2003
Publisher: Springer International Publishing
Published in: PharmacoEconomics / Issue 10/2003
Print ISSN: 1170-7690
Electronic ISSN: 1179-2027
DOI: https://doi.org/10.2165/00019053-200321100-00001

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Olanzapine versus Risperidone in the Treatment of Schizophrenia

A Comparison of Costs among Texas Medicaid Recipients

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 10/2003

Lower Respiratory Tract Infections

Cost Effectiveness of Adding Folinic Acid to Fluorouracil Plus Levamisole as Adjuvant Chemotherapy in Patients with Colon Cancer in Germany

Determinants of Drug Costs in Hospitalised Patients with Haemophilia

Cost-Effectiveness Analysis of Enoxaparin versus Unfractionated Heparin in Patients with Acute Coronary Syndrome in Poland

Consumer Preference for Dinoprostone Vaginal Gel Using Stated Preference Discrete Choice Modelling