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| |  DG DISPATCH - ECNP: Risperidone More Cost Effective Than Olanzapine By Cameron Johnston Special to DG News LONDON, UK -- September 24, 1999 -- Despite the fact that several studies involving as many as 2700 people have shown olanzapine (Zyprexa, Lilly) to be more effective in some ways at treating acute psychotic disorders, risperidone (Risperdal, Janssen-Cilag) is actually a more cost-effective medication - at least in Canada and the US.
At the annual meeting of the European College of Neuropsychopharmacology (ECNP), being held this week in London, UK, a compelling case was made that while one drug might be more effective at treating the disorder, that doesn’t mean it is always the best drug for the purpose. The evidence was presented at the ECNP by Dr. Ric Procyshyn, a clinical psycho-pharmacologist and an associate member of the department of psychiatry at the University of British Columbia, in Vancouver, Canada. The researchers obtained these results from naturalistic studies, which are designed to reflect what happens "in the real world", with real patients and real doctors, compared with what happens in artificially controlled, randomized clinical trials, Dr. Procyshyn said. "Randomized, controlled clinical trials need to be verified and confirmed using effectiveness studies involving non-selected patients under routine clinical treatment," he said. "This is particularly true in the case of schizophrenia, where controlled clinical trials are significantly different from routine clinical practice," he added. Dr. Procyshyn said the issue of cost became apparent when more atypical antipsychotics came on the market in the early 90s, and in response to government cutbacks in healthcare expenditure. In the study he conducted, the first 30 patients to be treated in the hospital were treated with risperidone and the next 30 were treated with olanzapine. Their progress was monitored over 120 days, which he said was the average length of hospital stay for patients with psychotic disorders. There was no demographic difference between the two treatment groups. Sixty percent of those treated with risperidone were defined as responders, although 37 percent had to be taken off the drug during the study because of lack of effect. By contrast, 27 percent of those on olanzapine were defined as responders, and 63 percent had to be taken of the drug because of lack of effect. In both cases, the differences were statistically significantly different. Dr. Procyshyn also found that 40 percent of the risperidone patients were discharged from the hospital still taking risperidone, and that 13 percent of those who started on olanzapine were discharged while still taking the drug. There was no difference between the numbers of patients who were switched because of adverse side effects. The average doses of the two drugs that brought treatment response were 4.9 mg/day with risperidone and 17.2 mg/day with olanzapine. Translating this into dollars and cents, he said it was possible to treat a patient effectively with risperidone, in a Canadian hospital, for $4.69 Cdn per day, while it cost $11.52 Cdn per day for olanzapine. In a similarly-structured study which also compared onset of action, it was found that patients taking risperidone showed a faster response than those taking olanzapine - 14 days versus 23 days. Translating this into dollars and cents, the person with schizophrenia could be treated effectively at a cost of $3.30 US for risperidone and $6.50 US for olanzapine. "This is how much it cost, per day to treat these patients effectively," Dr. Procyshyn said. In both studies, the lowest effective doses were in the order of 4 to 5 mg/day or risperidone and 14 to 17 mg/day for olanzapine. "The bottom line from these studies is that the acquisition costs for risperidone are two to four times lower than that of olanzapine without compromising efficacy," he said. "There’s no doubt that these atypicals are here to stay and that they have found their niche for the treatment of schizophrenia. The data speak for themselves that risperidone is more effective than olanzapine and I think that, as practitioners, we should keep this in mind in the decision-making process when we treat our patients."
Related Links: Zyprexa and Risperdal.
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