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Use of Novel Antipsychotic Shows Decreased Rehospitalization Rates Lower Doses Improve Outcomes, Lower Cost of Treating Schizophrenia
Long-term outcomes for patients with schizophrenia have been disappointing. Treatment using conventional antipsychotics show high rates of recidivism which, in turn, is costly for the system. However, new findings by researchers from the University of Maryland show that patients treated with the novel antipsychotic risperidone (brand name RisperdalÆ) experienced a lower readmission rate than patients who received conventional antipsychotic treatment.
The study team, lead by Dr. Robert Conley, assistant professor of psychiatry at the University of Maryland School of Medicine, along with Dr. Raymond Love, director of the Mental Health Program at the University of Maryland School of Pharmacy, and Dr. Deanna Kelly, instructor at the School of Medicine, found that after one year, the rehospitalization rate for patients treated with risperidone for schizophrenia or schizoaffective disorder was 17 percent, which compares favorably to previously published rates of as high as 50 percent using conventional antipsychotics.
"This study shows that in a real-world setting, the benefits of novel antipsychotics include improvements in the patients' quality of life and potential monetary savings," said Conley. "This evidence suggests that the higher cost of these novel agents can be made up for in terms of dollar savings from fewer readmissions."
In a separate but related study, Dr. Conley's team analyzed risperidone dosing trends in schizophrenia patients within the Maryland Mental Health System between 1994 and 1996, the first such study in a large population. They determined that patients successfully discharged on risperidone were treated with significantly lower doses than those who remained hospitalized.
"The importance of establishing effective dosing regimens cannot be understated," said Conley. "Patients who are under dosed or who receive excessive doses may fail to respond or could experience negative side-effects, which, in turn, could lead to drug discontinuation by clinicians or noncompliance by patients. Higher doses also may mean higher costs."
Love pointed out that another benefit of using lower doses of risperidone may be a decrease in costs per patient treated. In 1996, the cost for a patient receiving the average discharge dose of risperidone was approximately $1,900 compared to $2,450 for a patient receiving the average dose reported for those who remained hospitalized. Recent reports from Maryland's Statewide Pharmacy and Therapeutics Committee show that the average daily dose of the antipsychotic olanzapine (brand name ZyprexaÆ) was $3,350 for discharged patients and $4,000 for those who remained hospitalized.
"Although the availability of a newer generation of antipsychotics has resulted in savings by reducing hospitalization, the higher costs of these medications may offset some of those savings," said Love. "This study shows that at least for risperidone, use of lower doses may produce better outcomes as well as reduce costs."
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