Two Yale studies question the economics of medications in the two most widely prescribed and costly classes of psychiatric medications. One study found that a new and more expensive anti-psychotic drug is not more effective than a less costly, older one, and the second study found that industry-associated economic studies of antidepressants favor the companies' new drugs when determining costs and cost-effectiveness.
Costs and value of newer medications are at the forefront of current debates including the purchase of medications from Canada and the new Medicare coverage of prescriptions.
The first study at 17 Veterans Affairs hospitals compared an older, pennies-a-day schizophrenia drug with a newer, more expensive one. There was little advantage to the higher priced drug, according to Robert Rosenheck, M.D., director of the VA's Northeast Program Evaluation Center in West Haven, a professor of psychiatry and public health at Yale Medical School, and the lead author of the study in the Nov. 26 issue of the Journal of the American Medical Association.
The study represents the first long-term, rigorously designed experimental study of the newer drug, olanzapine, which has U.S. sales of $2 billion annually. In fiscal 2002, the VA spent $208.5 million overall on atypical antipsychotics - $106.6 million for olanzapine alone.
The researchers compared haloperidol, a typical antipsychotic, to olanzapine, the most expensive among the newer atypical antipsychotics. The study found no differences between the drugs in reducing schizophrenia symptoms or improving quality of life.
Olanzapine costs more than $8 per day per patient, based on VA figures, compared to about six cents per day for haloperidol.
The second study by Bruce Baker, M.D., deputy director of the Treatment Research Program and assistant professor in the Department of Psychiatry, found that economic studies of newer antidepressants sponsored by drug companies favor the companies' own drugs over the older drugs to a greater extent than studies that are not sponsored by the industry.
In 2002 newer antidepressants were listed as five of the top 20 drugs by sales dollars and accounted for over nine billion dollars in sales.
Concern is widespread about potential sponsorship influence on research, especially in those studies focusing on the cost or cost-effectiveness of drugs. The quality of the available research about value and costs is recognized as critical.
Baker's study, in the December issue of the British Journal of Psychiatry, is the first to quantitatively analyze economic studies of psychiatric medications.
Citations:
Journal of the American Medical Association, 290: pp 2693-2702 (Nov. 26, 2003)
British Journal of Pyschiatry, 183: 498-506 (Dec 2003)
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