Atypical Antipsychotics Can Cost Less in Long Run

The setting: a typical community mental health center in northern Italy. The question: When schizophrenia patients are treated with atypical antipsychotics rather than typical ones, are their overall health care costs greater?

When a group of Italian researchers began to investigate that question, they thought the answer would be yes. Data indicated that the care of patients getting atypicals was found to cost double that of patients getting typical antipsychotics. Upon digging deeper into the statistics, however, they found the opposite answer. When the severity of patients’ symptoms at the start of the study was taken into consideration, use of atypicals didn’t cost any more than using typicals did.

The study was conducted by Mauro Percudani, M.D., a psychiatrist affiliated with Hospital Legnano in Milan, and by Corrado Barbui, M.D., a psychiatrist at the University of Verona. Results were published in the November 2003 Journal of Clinical Psychiatry.

During the latter half of 1999, Percudani and Barbui began to study 183 seriously mentally ill individuals (mostly with schizophrenia) who were receiving care at any of three community mental health centers in Legnano, a town in northern Italy. Of the 183 subjects, 110 were receiving typical antipsychotics, and the rest were prescribed atypical antipsychotics.

The 110 subjects getting the typical antipsychotics tended to have more chronic illness than the 73 getting atypicals did, although the difference was not statistically significant. All of the subjects continued to receive their care at these community mental health centers until the latter half of 2001, when the study by Percudani and Barbui ended.

The researchers used various tools to assess the subjects clinically and psychosocially, both at the start of the study and at its end. The investigators obtained, from the local Psychiatric Information Computerized System, information about community mental health, hospital, and residential services provided to the subjects during the two-year study period. The researchers obtained, from the subjects’ clinical records, information about the subjects’ psychotropic drug use, lab tests, and general practitioner visits during the two-year study period.

The investigators used these data to calculate the health care costs for each subject during the two-year period. They then combined the health care costs for all subjects on typical antipsychotics and the costs for all subjects on atypical antipsychotics. Finally, they compared health care costs for the typical-antipsychotic group with the costs for the atypical-antipsychotic group.

Total health care costs for those getting atypical antipsychotics were nearly double those for subjects getting typical antipsychotics, the researchers found. This difference was largely due to two factors—more inpatient hospital admission costs and higher psychotropic drug use costs for the atypical group.

In fact, psychotropic drug use accounted for 29 percent of the atypical group’s total health care costs, yet only 9 percent of the typical group’s. The difference was also due, to some extent, to the atypical group receiving more general practitioner consultations and lab tests than the typical group.

However, when the researchers took into consideration the severity of subjects’ symptoms at the start of the study, “no association was found between atypicals and increased total health costs. . .,” Percudani and Barbui asserted in their report. “[In other words] the severity of illness is more important than the agent prescribed.”

The study received no funding from commercial organizations.

The study, “Cost and Outcome Implications of Using Typical and Atypical Antipsychotics in Ordinary Practice in Italy,” is posted online at www.psychiatrist.com/privatepdf/2003/v64n11/v64n1103.pdf. ▪