A POPULATION-BASED COST-EFFECTIVENESS ANALYSIS OF OLANZAPINE AND RISPERIDONE AMONG AMBULATORY PATIENTS WITH SCHIZOPHRENIA
Main Article Content
Keywords
Drugs, antipsychotic, schizophrenia, cost effectiveness, database
Abstract
Background
Olanzapine and risperidone are atypical antipsychotics exhibiting different pharmacological properties
that are likely to translate into differences in outcomes, tolerability and safety. As well, their acquisition cost differs. These differences may impact their cost-effectiveness.
Objective
To estimate the incremental cost-effectiveness ratio (ICER) of olanzapine and risperidone in an outpatient population.
Methods
We carried out a cost-effectiveness analysis based on resource utilization data gathered from Quebec’s provincial health insurance board databases. Patients previously diagnosed with schizophrenia who
received a first prescription of olanzapine or risperidone between 1 January 1997 and 31 August 1999 were followed for 365 days. Absence of hospitalization for mental illness served as the clinical indicator of effectiveness. Direct health care costs for mental illness were considered. Adjusted ICERs were calculated, and their 95% confidence intervals (CI) were assessed using a non-parametric bootstrap.
Results
A total of 6,334 patients were included in the analysis. The ICER for olanzapine was (CA$) 86,918
(95%CI, 27,709 to 237,040) per additional effective treatment per year, among patien ts hospitalized prior to their treatment. Among those who were not hospitalized prior to their treatment, olanzapine was dominated (95%CI, CA$1.7M to dominated).
Conclusion
Results suggest that, in this population, direct mental health care costs could be minimized by using
risperidone instead of olanzapine as the initial treatment.
References
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18. Lecomte P, De Hert M, van Dijk M, Nuijten M, Nuyts G, Persson U. A 1-year cost-effectiveness A population-based cost-effectiveness analysis of olanzapine and risperidone among ambulatory patients with schizophrenia model for the treatment of chronic schizophrenia with acute exacerbations in Belgium. Value in Health 2000;3(1):1-11.
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20. Palmer CS, Revicki DA, Genduso LA, Hamilton SH, Brown RE. A cost-effectiveness clinical decision analysis model for schizophrenia. Am J Manag Care 1998;4(3):345-55.
21. Edgell ET, Andersen SW, Johnstone BM, Dulisse B, Revicki D, Breier A. Olanzapine versus risperidone. A prospective comparison of clinical and economic outcomes in schizophrenia. Pharmacoeconomics 2000;18(6):567-79.
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33. Koro CE, Fedder DO, L'Italien GJ, et al. Assessment of independent effect of olanzapine and risperidone on risk of diabetes among patients with schizophrenia: population based nested case-control study. BMJ 2002;325(7358):243.
34. Leslie DL, Rosenheck RA. Incidence of newly diagnosed diabetes attributable to atypical antipsychotic medications. Am J Psychiatry 2004;161(9):1709-11.
35. Moisan J, Grégoire J-P, Gaudet M, Cooper D. Exploring the risk of diabetes mellitus and dyslipidemia among ambulatory users of atypical antipsychotics: a population-based comparison of risperidone and olanzapine. Pharmacoepidemiology and Drug Safety 2005;14(6):427-36.
36. Koro CE, Fedder DO, L'Italien GJ, et al. An assessment of the independent effects of olanzapine and risperidone exposure on the risk of hyperlipidemia in schizophrenic patients. Arch Gen Psychiatry 2002;59(11):1021-6.
37. Meyer JM, Koro CE. The effects of antipsychotic therapy on serum lipids: a comprehensive review. Schizophr Res 2004;70(1):1-17.
38. Rosenheck R, Leslie D, Keefe R, et al. Barriers to employment for people with schizophrenia. Am J Psychiatry 2006;163(3):411-17. 39. Mullins CD. Double counting and the reporting of cost per event avoided. Clin Ther 2006;28(4):602. 40. Liste de médicaments. 18 ed: Régie de l'assurance maladie du Québec; 2007.
2. Goeree R, Farahati F, Burke N, et al. The economic burden of schizophrenia in Canada in 2004. Curr Med Res Opin 2005;21(12):2017-28.
3. Tollefson GD, Beasley CM, Jr., Tran PV, et al. Olanzapine versus haloperidol in the treatment of schizophrenia and schizoaffective and schizophreniform disorders: results of an international collaborative trial. Am J Psychiatry 1997;154(4):457-65.
4. Hamilton SH, Revicki DA, Edgell ET, Genduso LA, Tollefson G. Clinical and economic outcomes of Olanzapine compared with Haloperidol for schizophrenia. Pharmacoeconomics 1999;15(5):469-80.
5. Chouinard G, Jones B, Remington G, et al. A Canadian multicenter placebo-controlled study of fixed doses of risperidone and haloperidol in the treatment of chronic schizophrenic patients. J Clin Psychopharmacology 1993;13:25-40.
6. Markowitz JS, Brown CS, Moore TR. Atypical antipsychotics. Part I: Pharmacology, pharmacokinetics, and efficacy. Ann Pharmacother 1999;33(1):73-85.
7. Kasper S, Jones M, Duchesne I. Risperidone olanzapine drug outcomes studies in schizophrenia (RODOS): health economic results of an international naturalistic study. Int Clin Psychopharmacol 2001;16(4):189-96.
8. Glennie JL. Évaluation pharmacoéconomique de la clozapine dans le traitement de la schizophrénie réfractaire et de la rispéridone dans le traitement de la schizophrénie chronique. Ottawa:ON: OCCETS; 1997 Juillet.
9. Moisan J, Grégoire J-P, Chabot I. Risperidone and olanzapine use at a psychiatric hospital: comparison of clinical use and acquisition costs. Can J Hosp Pharm 2001;54:278-83.
10. Procyshyn RM, Zerjav S. Drug utilization patterns and outcomes associated with inhospital treatment with risperidone or olanzapine. Clin Ther 1998;20(6):1203-17. 11. Taylor DM, Wright T, Libretto SE. Risperidone compared with olanzapine in a naturalistic clinical study: a cost analysis. J Clin Psychiatry 2003;64(5):589-97.
12. Lieberman JA, Stroup TS, McEvoy JP, et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 2005;353(12):1209-23.
13. Cooper D, Moisan J, Gaudet M, Abdous B, Grégoire J-P. Ambulatory use of olanzapine and risperidone: A population-based study on persistence and the use of concomitant therapy in the treatment of schizophrenia. Can J Psychiatry 2005;50(14):901-8.
14. Rosenheck RA, Leslie DL, Sindelar J, et al. Cost-effectiveness of second-generation antipsychotics and perphenazine in a randomized trial of treatment for chronic schizophrenia. Am J Psychiatry 2006;163:208089.
15. Kopala L, Smith G, Malla A, et al. Resource utilization in a Canadian national study of people with schizophrenia and related psychotic disorders. Acta Psychiatr Scand 2006;113 Suppl 430:29-39.
16. Zhao Z. A retrospective economic evaluation of olanzapine versus risperidone in the treatment of schizophrenia. Manag Care Interface 2002;15(2):75-81.
17. Rascati KL, Johnsrud MT, Crismon ML, Lage MJ, Barber BL. Olanzapine versus risperidone in the treatment of schizophrenia: a comparison of costs among Texas Medicaid recipients. Pharmacoeconomics 2003;21(10):683-97.
18. Lecomte P, De Hert M, van Dijk M, Nuijten M, Nuyts G, Persson U. A 1-year cost-effectiveness A population-based cost-effectiveness analysis of olanzapine and risperidone among ambulatory patients with schizophrenia model for the treatment of chronic schizophrenia with acute exacerbations in Belgium. Value in Health 2000;3(1):1-11.
19. Lewis M, McCrone P, Frangou S. Service use and costs of treating schizophrenia with atypical antipsychotics. J Clin Psychiatry 2001;62(10):74956.
20. Palmer CS, Revicki DA, Genduso LA, Hamilton SH, Brown RE. A cost-effectiveness clinical decision analysis model for schizophrenia. Am J Manag Care 1998;4(3):345-55.
21. Edgell ET, Andersen SW, Johnstone BM, Dulisse B, Revicki D, Breier A. Olanzapine versus risperidone. A prospective comparison of clinical and economic outcomes in schizophrenia. Pharmacoeconomics 2000;18(6):567-79.
22. Kasper S, Rosillon D, Duchesne I. Risperidone olanzapine drug outcomes studies in schizophrenia (RODOS): efficacy and tolerability results of an international naturalistic study. Int Clin Psychopharmacol 2001;16(4):17987.
23. Tamblyn R, Lavoie G, Petrella L, Monette J. The use of prescription claims databases in pharmacoepidemiological research: the accuracy and comprehensiveness of the prescription claims database in Québec. J Clin Epidemiol 1995;48(8):999-1009.
24. Clark DO, Von Korff M, Saunders K, Baluch WM, Simon GE. A chronic disease score with empirically derived weights. Med Care 1995;33(8):783-95.
25. Centre Hospitalier Robert-Giffard affilié à l'Université Laval. Rapport annuel 2000-2001. Beauport.
26. WHO Collaborating Centre for Drug Statistics Methodology. Anatomical Therapeutic Chemical (ATC) Classification Index. Oslo; 2000.
27. Rothman KJ, Greenland S. Concepts of interaction. In: Modern epidemiology. Second ed. Philadelphia: Lippincott, Williams and Wilkins; 1998:329-42.
28. Duan N. Smearing estimate: a nonparametric retransformation method. J Am Stat Assoc 1983;78(383):605-10.
29. Efron B, Gong G. A leisurely look at the Bootstrap, Jacknife and cross-validation. Am Stat 1983;1:36-48.
30. Chaudhary M, Stearns S. Estimating confidence intervals for cost-effectiveness ratios: an example from a randomized trial. Stat Med 1996;15:1447-58.
31. SAS OnlineDoc, Version 9.1.3 2008. Accessed at: http://support.sas.com/onlinedoc/913/docMainpa ge.jsp
32. Tran PV, Hamilton SH, Kuntz AJ, et al. Doubleblind comparison of olanzapine versus risperidone in the treatment of schizophrenia and other psychotic disorders. J Clin Psychopharmacol 1997;17(5):407-18.
33. Koro CE, Fedder DO, L'Italien GJ, et al. Assessment of independent effect of olanzapine and risperidone on risk of diabetes among patients with schizophrenia: population based nested case-control study. BMJ 2002;325(7358):243.
34. Leslie DL, Rosenheck RA. Incidence of newly diagnosed diabetes attributable to atypical antipsychotic medications. Am J Psychiatry 2004;161(9):1709-11.
35. Moisan J, Grégoire J-P, Gaudet M, Cooper D. Exploring the risk of diabetes mellitus and dyslipidemia among ambulatory users of atypical antipsychotics: a population-based comparison of risperidone and olanzapine. Pharmacoepidemiology and Drug Safety 2005;14(6):427-36.
36. Koro CE, Fedder DO, L'Italien GJ, et al. An assessment of the independent effects of olanzapine and risperidone exposure on the risk of hyperlipidemia in schizophrenic patients. Arch Gen Psychiatry 2002;59(11):1021-6.
37. Meyer JM, Koro CE. The effects of antipsychotic therapy on serum lipids: a comprehensive review. Schizophr Res 2004;70(1):1-17.
38. Rosenheck R, Leslie D, Keefe R, et al. Barriers to employment for people with schizophrenia. Am J Psychiatry 2006;163(3):411-17. 39. Mullins CD. Double counting and the reporting of cost per event avoided. Clin Ther 2006;28(4):602. 40. Liste de médicaments. 18 ed: Régie de l'assurance maladie du Québec; 2007.
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Dec 8, 2018
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Cooper, D., Moisan, J., Abdous, B., & Grégoire, J.-P. (2018). A POPULATION-BASED COST-EFFECTIVENESS ANALYSIS OF OLANZAPINE AND RISPERIDONE AMONG AMBULATORY PATIENTS WITH SCHIZOPHRENIA. Journal of Population Therapeutics and Clinical Pharmacology, 15(3). https://mail.jptcp.com/index.php/jptcp/article/view/229
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How to Cite
Cooper, D., Moisan, J., Abdous, B., & Grégoire, J.-P. (2018). A POPULATION-BASED COST-EFFECTIVENESS ANALYSIS OF OLANZAPINE AND RISPERIDONE AMONG AMBULATORY PATIENTS WITH SCHIZOPHRENIA. Journal of Population Therapeutics and Clinical Pharmacology, 15(3). https://mail.jptcp.com/index.php/jptcp/article/view/229