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Cost and Cost-Effectiveness in a Randomized Trial of Long-Acting Risperidone for Schizophrenia

J Clin Psychiatry 2012;73(5):696-702
10.4088/JCP.11m07070

Objective: The effect of long-acting injectable (LAI) risperidone on health care costs was determined in a multisite clinical trial.

Method: Veterans Health Administration patients with unstable schizophrenia or schizoaffective disorder established by the Structured Clinical Interview for DSM-IV (N = 369) were randomized between 2006 and 2009 to long-acting risperidone or physician’s choice of oral antipsychotic. Health care utilization and cost were tracked in administrative data. Medication administered by the trial was recorded on case report forms. Medication cost was based on unit costs to the US Medicaid program. Economic outcomes were assessed with the Quality of Well-Being instrument.

Results: Participants randomized to LAI risperidone (n = 187) incurred $14,916 per quarter in total health care costs, which was not significantly different from the $13,980 cost incurred by the control group (P = .732) (n = 182). The LAI group incurred $3,028 per quarter in medication cost, significantly more than the $1,913 incurred by the control group (P = .003). Hospitalization costs were $7,088 in the experimental group and $6,891 in the control group (P = .943); outpatient costs were $11,888 in the experimental group and $12,067 in the control group (P = .639). LAI risperidone did not result in better outcomes as evaluated by a measure of schizophrenia symptoms or an assessment of health related quality of life and incurred more adverse events.

Conclusions: Patients with unstable schizophrenia were randomized in a practical trial of LAI risperidone. This antipsychotic significantly increased medication costs but did not reduce hospital or total health care cost or improve outcomes and was thus not cost-effective.

Trial Registration: ClinicalTrials.gov identifier: NCT00132314

J Clin Psychiatry 2012;73(5):696–702

Submitted: April 14, 2011; accepted August 15, 2011(doi:10.4088/JCP.11m07070).

Corresponding author: Paul G. Barnett, PhD, Health Economics Resource Center, VA Cooperative Studies Program, VA Palo Alto Health Care System, 795 Willow Rd (152), Menlo Park, CA 94025 (paul.barnett@va.gov).