Cost Of Risperidone Research Articles

Risperidone cost saving for schizophrenia in Uganda

Risperidone cost saving for schizophrenia in Uganda

The impact of reference pricing and extension of generic substitution on the daily cost of antipsychotic medication in Finland.

ObjectiveTo assess the impact of reference pricing and extension of generic substitution on the daily cost of antipsychotic drugs in Finland during the first year after its launch. Furthermore, the additional impact of reference pricing on prior implemented generic substitution is assessed.MethodsA retrospective analysis was performed between 2006 and 2010. A segmented linear regression analysis of interrupted time series was used to estimate changes in the levels and trends in the cost of one day of treatment. Of the study drugs, clozapine belonged to generic substitution already at the start of the study period while olanzapine and quetiapine were included in generic substitution alongside with reference pricing in 2009. Risperidone was included in generic substitution in 2008, before reference pricing.ResultsA substantial decrease in the daily cost of all four antipsychotic substances was seen after one year of the implementation of reference pricing and the extension of generic substitution. The impact ranged from -29.9% to -66.3%, and it was most substantial on the daily cost of olanzapine. Also in the daily cost of risperidone a substantial decrease of -43.3% was observed. However, most of these savings, -32.6%, were generated by generic substitution which had been adopted prior.ConclusionsReference pricing and the extension of generic substitution produced substantial savings on antipsychotic medication costs during the first year after its launch, but the intensity of the impact differed between active substances. Furthermore, our results suggest that the additional cost savings from reference pricing after prior implemented generic substitution, are comparatively low.Electronic supplementary materialThe online version of this article (doi:10.1186/s13561-014-0009-3) contains supplementary material, which is available to authorized users.

A Single Blind Comparative Clinical Study of the Effects of Chlorpromazine and Risperidone on Positive and Negative Symptoms in Patients of Schizophrenia

Objectives:The present study was undertaken to test the comparative efficacy of chlorpromazine and risperidone in patients of schizophrenia in a tertiary care hospital of Maharashtra.Materials and Methods:About 100 subjects of either sex between 15 and 75 years of age were randomly assigned either chlorpromazine or risperidone. Only those patients were included who met International Classification of Diseases 10 revision criteria by World Health Organization. To avoid bias, the test drugs were coded as A and B. The study coordinator was unaware of the prescribed drugs; however, the prescribing psychiatrist knew about the drug treatment.Results:Both chlorpromazine and risperidone significantly decreased the mean score of positive and general symptoms in patients of schizophrenia. Although chlorpromazine decreased the mean score of negative symptoms, it was not statistically significant. Risperidone reduced the mean score of negative symptoms to a significant extent. The cost (Rs. 3000-4000) of risperidone was more than the cost (Rs. 700-1000) of chlorpromazine per patient per annum. The dropouts were less (25%) in the risperidone group than in the chlorpromazine group (75%). The more purchase of risperidone than of chlorpromazine was observed in our study.Conclusion:The response rates for positive and general symptoms were found to be equal for both chlorpromazine and risperidone. However, risperidone was found to be more effective than chlorpromazine in treating negative symptoms. The dropout rate was less in the risperidone group than in the chlorpromazine group. The compliance was also better in the risperidone group, even though the cost of risperidone was more than that of chlorpromazine.

Long-acting risperidone cost saving in schizophrenia

Long-acting risperidone cost saving in schizophrenia

Long-acting risperidone cost saving in schizophrenia

Long-acting risperidone cost saving in schizophrenia

Effectiveness and Cost of Risperidone and Olanzapine for Schizophrenia

Risperidone and olanzapine are novel antipsychotic medications that compete as first-line agents in treating patients with schizophrenia. The objective of this paper is to review the available evidence regarding the effectiveness and cost of risperidone versus olanzapine. We reviewed both randomised and peer-reviewed non-randomised head-to-head (olanzapine versus risperidone) studies in populations with schizophrenia. The studies were selected through a MEDLINE search. Risperidone and olanzapine provide control of positive, negative and global symptoms of schizophrenia. Each drug has a distinct adverse effect profile. Five randomised trials comparing risperidone with olanzapine suggested grossly similar efficacy in the first 2 months of treatment, with some results indicating advantages for olanzapine over the longer term. Only two of the trials included measures of service utilisation. One had 28-week follow-up, and the other followed patients for 12 months but had small sample sizes. Both experimental and naturalistic studies indicated that the acquisition cost of olanzapine is about 50% greater than for risperidone at dose levels commonly used for the treatment of schizophrenia. The only experiment with 12-month total treatment cost data found essentially equivalent costs for patients assigned to olanzapine or risperidone, showing that there are circumstances where total cost is similar in spite of the higher drug acquisition cost of olanzapine. Most retrospective studies also reported comparable total cost. Few studies gave enough information to evaluate cost effectiveness. The clear difference in acquisition cost of these two medications was rarely reflected in overall treatment cost in the studies we reviewed. Overall, our review of the literature highlights that there is inadequate evidence to distinguish the relative total cost of care associated with risperidone versus olanzapine, although accumulating evidence suggests the difference is small. This population-based conclusion does not indicate which medication is more costly or more cost effective for a particular patient; this depends on each patient's response to each medication.

Assessing cost-effectiveness of drug interventions for schizophrenia

To assess from a health sector perspective the incremental cost-effectiveness of eight drug treatment scenarios for established schizophrenia. Using a standardized methodology, costs and outcomes are modelled over the lifetime of prevalent cases of schizophrenia in Australia in 2000. A two-stage approach to assessment of health benefit is used. The first stage involves a quantitative analysis based on disability-adjusted life years (DALYs) averted, using best available evidence. The robustness of results is tested using probabilistic uncertainty analysis. The second stage involves application of 'second filter' criteria (equity, strength of evidence, feasibility and acceptability) to allow broader concepts of benefit to be considered. Replacing oral typicals with risperidone or olanzapine has an incremental cost-effectiveness ratio (ICER) of 48,000 Australian dollars and 92,000 Australian dollars/DALY respectively. Switching from low-dose typicals to risperidone has an ICER of 80,000 Australian dollars. Giving risperidone to people experiencing side-effects on typicals is more cost-effective at 20,000 Australian dollars. Giving clozapine to people taking typicals, with the worst course of the disorder and either little or clear deterioration, is cost-effective at 42,000 Australian dollars or 23,000 Australian dollars/DALY respectively. The least cost-effective intervention is to replace risperidone with olanzapine at 160,000 Australian dollars/DALY. Based on an 50,000 Australian dollars/DALY threshold, low-dose typical neuroleptics are indicated as the treatment of choice for established schizophrenia, with risperidone being reserved for those experiencing moderate to severe side-effects on typicals. The more expensive olanzapine should only be prescribed when risperidone is not clinically indicated. The high cost of risperidone and olanzapine relative to modest health gains underlie this conclusion. Earlier introduction of clozapine however, would be cost-effective. This work is limited by weaknesses in trials (lack of long-term efficacy data, quality of life and consumer satisfaction evidence) and the translation of effect size into a DALY change. Some stakeholders, including SANE Australia, argue the modest health gains reported in the literature do not adequately reflect perceptions by patients, clinicians and carers, of improved quality of life with these atypicals.

Assessing Cost-Effectiveness of Drug Interventions for Schizophrenia

To assess from a health sector perspective the incremental cost-effectiveness of eight drug treatment scenarios for established schizophrenia. Using a standardized methodology, costs and outcomes are modelled over the lifetime of prevalent cases of schizophrenia in Australia in 2000. A two-stage approach to assessment of health benefit is used. The first stage involves a quantitative analysis based on disability-adjusted life years (DALYs) averted, using best available evidence. The robustness of results is tested using probabilistic uncertainty analysis. The second stage involves application of 'second filter' criteria (equity, strength of evidence, feasibility and acceptability) to allow broader concepts of benefit to be considered. Replacing oral typicals with risperidone or olanzapine has an incremental cost-effectiveness ratio (ICER) of 48,000 Australian dollars and 92,000 Australian dollars/DALY respectively. Switching from low-dose typicals to risperidone has an ICER of 80,000 Australian dollars. Giving risperidone to people experiencing side-effects on typicals is more cost-effective at 20,000 Australian dollars. Giving clozapine to people taking typicals, with the worst course of the disorder and either little or clear deterioration, is cost-effective at 42,000 Australian dollars or 23,000 Australian dollars/DALY respectively. The least cost-effective intervention is to replace risperidone with olanzapine at 160,000 Australian dollars/DALY. Based on an 50,000 Australian dollars/DALY threshold, low-dose typical neuroleptics are indicated as the treatment of choice for established schizophrenia, with risperidone being reserved for those experiencing moderate to severe side-effects on typicals. The more expensive olanzapine should only be prescribed when risperidone is not clinically indicated. The high cost of risperidone and olanzapine relative to modest health gains underlie this conclusion. Earlier introduction of clozapine however, would be cost-effective. This work is limited by weaknesses in trials (lack of long-term efficacy data, quality of life and consumer satisfaction evidence) and the translation of effect size into a DALY change. Some stakeholders, including SANE Australia, argue the modest health gains reported in the literature do not adequately reflect perceptions by patients, clinicians and carers, of improved quality of life with these atypicals.

Pharmacy cost evaluation of risperidone, olanzapine, and quetiapine for the treatment of schizophrenia in acute care inpatient settings

SUMMARYObjective: This study examines total pharmacy cost and usage patterns of schizophrenic patients in acute mental health inpatient settings for three atypical antipsychotics – risperidone, olanzapine, and quetiapine. Despite the readily available unit cost information for drugs, actual pharmacy costs may deviate significantly from ‘labeled costs’. Recent research findings indicate the need for more robust evaluation of such pharmacy costs.Research design and methods: This study used data from non-randomized inpatient retrospective charts from three acute care inpatient mental health facilities. The final pooled sample included 327 patients, of which 120 received risperidone, 153 received olanzapine, and 54 received quetiapine. Medication cost was defined as the average wholesale price (AWP) as listed in the 2001 ‘Red Book’. Propensity scoring methodology and multinomial regression were employed to reduce treatment selection bias.Results: The observed mean daily antipsychotic drug doses were 4.45 mg (SD 2.44) for risperidone, 14.04 mg (SD 5.55) for olanzapine, and 350.33 mg (SD 228.24) for quetiapine. The corresponding mean daily drug costs were $7.66(SD $4.20) for risperidone, $8.11 (SD $5.29) for quetiapine and, $12.10 (SD $4.79) for olanzepine. Numbers adjusted for treatment selection bias show that the average daily total pharmacy cost of risperidone was $4.35 lower than olanzapine ( p < 0.001) and $1.41 lower than quetiapine ( p = 0.38). The adjusted average daily pharmacy cost of olanzapine was $4.02 higher than quetiapine ( p < 0.001). After statistical adjustment there were no significant differences between study drugs in terms of length of stay or patient functioning.Conclusion: This study provides the first US comparison of medication utilization patterns and pharmacy costs for olanzapine, risperidone, and quetiapine administered in acute mental health care inpatient settings. While this study did not estimate the full economic value of the three antipsychotics in these inpatient settings, it demonstrated that the mean daily costs for risperidone were lower than the mean daily costs for olanzapine ( p < 0.001) and quetiapine although the later difference was not statistically significant ( p = 0.38).

Risperidone cost study findings disputed

Risperidone cost study findings disputed

Future employability, a new approach to cost-effectiveness analysis of antipsychotic therapy

Objective: Schizophrenia patients pose a substantial burden in terms of indirect costs, much of which is attributable to loss of employment. We present a new approach to assess the cost-effectiveness (CE) of risperidone vs. haloperidol using employability as an outcome measure. Methods: A decision analytic CE model was developed to compare the two treatments over a 1-year period including all direct medical costs and the number of employable persons as a measure of effectiveness. A measure of executive functioning, the Wisconsin Card Sorting Test Category score (WCST-Cat score), was used as an intermediate endpoint from which employability was modeled. A Monte Carlo procedure, using WCST-Cat score sampling distributions from clinical trials, simulated the WCST-Cat score distribution for a cohort of 10,000 patients. A clinically stable patient, with a Positive and Negative Syndrome Scale (PANSS) score increase of at least 20% and a WCST-Cat score of ≥3.5 was assumed to be employable. Sensitivity analysis was performed for key values. Results: The base case per-patient cost of risperidone and haloperidol was US$6422 and US$4989, respectively, and the number of employable persons was 3258 (32.58%) and 2517 (25.17%), respectively, which translates to an incremental CE ratio of US$19,609 per employable person for risperidone. Risperidone remained cost increasing and had higher number of employable persons over all the ranges used in the sensitivity analysis. The incremental CE ratio ranged from a high of US$1,000,000 to a low of US$3000 per employable persons when the rates of clinical stability for risperidone and haloperidol therapy were varied. Conclusion: Gains from earning rates for employed persons with schizophrenia, savings in informal caregiver costs and other human benefits could justify an incremental cost of US$19,609 for each additional employable person prescribed risperidone.

Outcomes and costs of treatment with risperidone in adult and elderly patients: the Delta patient using risperidone study

Purpose: The primary aim of the present study (called DePUR: Delta patients using risperidone) was to compare patient characteristics, treatment outcome variables and medication costs of adult and elderly patients treated with risperidone. Methods: In a single-centre retrospective study, the following data were extracted from the medical records of 32 adult (<65 years) and 32 elderly (≥65 years) inpatients to whom risperidone was prescribed shortly after admission: demographic data, diagnosis, medication and hospitalisation history, all drugs taken during admission, treatment effectiveness of risperidone, reported adverse events. These data were collected for the period from admission until discharge or until they had been hospitalised for 120 days. Results: Most patients (81% of adult patients and 91% of elderly patients) received risperidone for a psychiatric disease other than schizophrenia. In elderly patients, major depressive disorder with psychotic features was the most frequent diagnosis. Treatment with risperidone was in most cases effective (72% and 74%, respectively), but effectiveness was established sooner in the adult patients than in the elderly patients (7 versus 14 days). The length of stay in hospital was shorter in adults than in elderly (38.5 versus 92.7 days). The daily dose of risperidone was higher in adults than in elderly patients (3.6 versus 1.7 mg per day). Contrary to expectations, daily drug cost of risperidone and daily drug cost of all inpatient drugs were not cheaper in adult patients than in the elderly, mainly due to a higher dose of risperidone and a higher consumption of antipsychotic co-medication in adults. Conclusion: Risperidone is prescribed successfully for many other psychotic features than for schizophrenia. Treatment of elderly patients in our clinic does not require higher daily medication costs than for adult patients.

MH2: FUTURE EMPLOYABILITY: A NEW APPROACH TO COST-EFFECTIVENESS ANALYSIS OF ANTIPSYCHOTIC THERAPY

OBJECTIVE: Antipsychotic therapies are often evaluated on the basis of clinical endpoints (BPRS, PANSS) and measures of direct cost. However, schizophrenia patients pose a substantial burden in terms of indirect costs, much of which is attributable to loss of employment. We present a new approach to assess the cost-effectiveness of Risperidone Vs Haloperidol, using employability as an outcome measure. METHODS: A decision analytic cost-effectiveness model was developed to compare the two treatments over a one-year period including all direct medical costs and the number of employable persons as a measure of effectiveness. A measure of executive functioning, the Wisconsin Card Sort Test (WCST), was used as an intermediate endpoint from which employability was modeled. A Monte-Carlo procedure, using WCST sampling distributions from clinical trials, simulated the WCST score distribution for a cohort of 10,000 patients. A clinically stable patient, with a Positive and Negative Syndrome Scale (PANSS) score increase of at least 20% and a WCST-Category score of 3.5 was assumed to be employable. Sensitivity analysis was performed for key values. RESULTS: The base case per-patient cost of Risperidone and Haloperidol was $5,967 and $4,622 respectively and the number of employable persons was 3,258 (32.58%) and 2,517 (25.17%) respectively. Risperidone remained cost increasing and had higher number of employable persons over all the ranges used in the sensitivity analysis. The base case incremental cost-effectiveness ratio for Risperidone was $14,507 for each additional employable person. The incremental CE ratio ranged from a high of $100,000 to a low of $3,000 per employable persons when the rates of clinical stability for Risperidone and Haloperidol therapy were varied. CONCLUSION: Gains from earning rates for employed schizophrenics, savings in informal caregiver costs and other intangible positive effects could justify an incremental cost of $14,507 for each additional employable person prescribed Risperidone.

Risperidone cost advantage over olanzapine in schizophrenia

Risperidone cost advantage over olanzapine in schizophrenia

Effectiveness of Antipsychotic Therapy in a Naturalistic Setting

Therapeutic ineffectiveness and noncompliance with antipsychotic agents are major contributors to rehospitalization in patients with psychotic disorders. It is unknown whether risperidone's favorable side effect profile compared with that of the conventional antipsychotics results in improved compliance and reduced hospitalizations in a naturalistic setting. The purpose of this study was to test the hypothesis that treatment with risperidone reduces readmission rates and associated costs when compared with treatment with perphenazine or haloperidol. Inpatients prescribed either risperidone, perphenazine, or haloperidol between January 1, 1995, and December 31, 1995, as a single oral antipsychotic at discharge were retrospectively identified. Data were collected for that index hospitalization and for a 1-year follow-up period. Primary outcome measures included re-admission rates, changes in antipsychotic therapy, anticholinergic drug use, and costs. There were 202 evaluable patients (81 treated with risperidone, 78 with perphenazine, and 43 with haloperidol). Baseline demographics were similar between groups except that more patients in the risperidone group had a primary diagnosis of psychotic disorder or had been hospitalized in the year prior to study. The percentage of patients readmitted during the 1-year follow-up period was similar among drug groups (41% risperidone, 26% perphenazine, and 35% haloperidol) when controlled for baseline differences in diagnosis and hospitalization history (p = .32). Anticholinergic drug use was more common in the haloperidol group (p = .004). Mean yearly cost (drug + hospitalization) in the risperidone group was $20,317, nearly double that in the other treatment groups (p < .001). The results from this naturalistic study indicate that the high cost of risperidone is not offset by a reduction in readmission rates when compared with conventional antipsychotics.

Risperidone cost effective for improving QOL in schizophrenia

Risperidone cost effective for improving QOL in schizophrenia

Risperidone cost effective for improving QOL in schizophrenia

Risperidone cost effective for improving QOL in schizophrenia