Pharmacoeconomic evaluation of long-term treatment with risperidone for patients with chronic schizophrenia.

Authors: JF Guest, WM Hart, RF Cookson & E Lindstrom.
Source: British Journal of Medical Economics 1996; 10: 59-67.

ABSTRACT

Risperidone (Risperdal^TM, Janssen-Cilag) is an effective treatment for schizophrenia but no UK data on cost implications exist. UK costs of direct NHS and local authority resources (at 1993/4 prices) were applied to results from a two-year Swedish trial involving 31 patients with chronic schizophrenia. Resource utilisation data collected during two years of risperidone treatment (Y1 and Y2) were compared with data from the year before risperidone treatment (Y0).

Patients had a mean age of 38 years, and there were means of 17 years since diagnosis and 10.7 previous hospital admissions. Previous treatments in Y0 included thioridazine (12), zuclopenthixol (10), perphenazine (7) and clozapine (2). Mean Positive and Negative Syndrome Scale for Schizophrenia scores (± sd) fell from 86.7 ± 16.6 at the end of Y0 to 59.9 ± 19.3 after Y1 (p < 0.0001) and 55.4 ± 17.5 after Y2 (p < 0.0002). Mean hospital stay decreased from 171.8 ± 150.3 days in Y0 to 118.9 ± 147 in Y1, (p < 0.02). Residential accommodation stay increased from 28.4 ± 82.6 to 84.7 ± 143.3 days, respectively (p < 0.03). The total mean cost per patient fell from £22,362 in Y0 to £21,174 in Y1. In 18 of these patients followed for two years, the mean cost per patient fell to £19,828 in Y1, and £12,402 in Y2. Decreased hospital stay was the biggest factor affected by these reductions. Sensitivity analysis demonstrated potential savings to society for prices above £95 per hospital day.

These findings suggest that switching patients suffering from chronic schizophrenia to treatment with risperidone results in clinical improvements which potentially reduce costs to the NHS and local authorities. Savings are largely due to decreased hospitalisation, and offset the increased costs of drug treatment and residential accomodation.