That’s a question Psychiatric News posed to several experts following a report in Psychiatric Services in Advance that concluded the long-acting injectable paliperidone, a second generation antipsychotic, is not as cost-effective as haliperidone, despite having a slight advantage in terms of clinical effectiveness.
In the study, Robert Rosenheck, M.D., a professor of psychiatry and public health at Yale Medical School, and colleagues randomized a total of 311 adults with schizophrenia or schizoaffective disorder to monthly intramuscular injections of haliperidone (25 mg to 200 mg) or paliperidone (39 mg to 234 mg) for up to 24 months.
Results showed that paliperidone was associated with a small but statistically significant health advantage over haliperidone—as measured by “quality-adjusted life years.” The cost of paliperidone ran on average $2,100 more per quarter for inpatient and outpatient services and medication compared with haliperidone.
“The results of this study should encourage consideration of older, less expensive drugs, such as HD [haliperidone deconate],” Rosenheck and colleagues wrote. “[A] rational policy for treatment of chronic schizophrenia might limit use of the more expensive LAIs to patients who do not benefit from or cannot tolerate HD.”
In an interview with Psychiatric News, Rosenheck said the results should be useful to payers and policymakers. Clinicians also have a responsibility to pay attention to cost-effectiveness. “If psychiatrists don’t play a role in developing a scientific basis for cost-effectiveness, then the only people who are setting the agenda are those whose main interest is profit,” he said.
Jim Sabin, M.D., director of the ethics program at Harvard Pilgrim Health Care, said decisions about allocation of resources for medications that are marginally more effective but significantly more costly can be made ethically and rationally within a system of care (as opposed to ad hoc decision-making by individual prescribers) that accommodates the imperatives of population health and patient preferences.
“A well-functioning system serves both perspectives,” he told Psychiatric News.
For more coverage of the Rosenheck study—including an explanation of cost-effectiveness methodology—see the Psychiatric News PsychoPharm article “How Much Should Psychiatrists Weigh Costs When Prescribing?”
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