Rosenheck said he does not see the study as prompting a return to the older class of schizophrenia drugs. The newer atypical antipsychotics have become widely accepted over the past 10 years as the first-line choice for treating schizophrenia. But he did say the findings sharply challenge the perception that olanzapine, while costlier at the pharmacy, more than pays for itself by lowering overall health-care and social service costs for its users. In the study, olanzapine was associated with $3,000 to $9,000 in greater annual VA costs per patient-mostly due to the higher cost of the drug.
"This study suggests that the advantages of olanzapine may be limited, while costs are considerably greater," said Rosenheck. "As a nation we are spending $2 billion annually on a treatment whose advantage over less expensive treatments is questionable and which may incur adverse health effects related to weight gain."
He said the findings support VA's current prescribing guidelines-"that physicians should try cheaper drugs before more expensive ones, as long as they are similarly effective."
VA guidelines recommend risperidone or quetiapine, two other atypical antipsychotics, as first choices for treating schizophrenia. Olanzapine, along with the atypicals ziprasidone and clozapine, is a second-line drug. Typical antipsychotic drugs such as haloperidol are only recommended when patients fail to respond to the above treatment. Physicians are free in all cases to use their discretion, based on the individual patient.
Risperidone costs about half as much as olanzapine, and has shown equal benefits in most clinical trials. According to 2002 figures from VA's National Psychosis Registry, more than 80 percent of VA patients with schizo
'"/>
Contact: Pamela Redmond
pamela.redmond@mail.va.gov
203-937-3824
VA Research Communications Service
25-Nov-2003