Current debates on determining most cost effective treatment for psychosis and bipolar i manic / mixed states
Abstract
s of the Speakers / Konuşmacı ÖzetleriInclusion of second-generation antipsychotics (SGAs) into psychiatric armamentarium has changed not only the quality of life and functioning of patients with severe psychiatric disorders but also public and professional perception of such disorders and antipsychotic drugs. Most unpleasant adverse effects experienced with first-generation antipsychotic drugs (FGAs) for example, depressed mood, cognitive impairment, extrapyramidal side effects, tardive dyskinesia, endocrine and cardiac risks were either absent or minimally present with SGAs (1,2). These positive perceptions on the measures of safety and tolerability as well as accumulation of efficacy data on psychotic disorders and bipolar manic / mixed states along with hard-to-treat depressive episodes increased prescription of SGAs substantially. Consequently, nowadays more antipsychotic drugs are being prescribed on a broader range of psychiatric conditions compared to past (3–5). Roughly, more than three quarters of the prescribed antipsychotics are SGAs and average cost of a SGA is roughly 10–50 times more than a classical antipsychotic (5, 6). These observations and facts on top of global financial difficulties prompted health care systems internationally to search for justifications for use of cheaper treatment alternatives and more cost effective employment of expensive ones (6). As such several recent meta-analyses assessed efficacy, safety, and tolerability of SGAs over FGAs and/or other medications for treatment of psychosis and bipolar manic / mixed states (5–8). A large meta-analysis involving 114 studies compared efficacy and safety of SGAs versus FGAs in treatment of schizophrenia or related psychosis (6). Broad inclusion criteria allowed blind and open, randomized and non-randomized controlled trials with study durations ranging from less than 1 day to 4 years as well as retrospective cohort studies with study durations ranging from 3 to 22 years (6). More than half of the included studies was multi-centered (54%) and supported by pharmaceutical industry (68%). In terms of efficacy moderate strength evidence showed a benefit for risperidone compared with haloperidol on the Positive and Negative Syndrome Scale (PANSS); difference was not considered clinically important. S15 Journal of Mood Disorders Volume: 3, Supplement: 1, 2013 - www.jmood.org
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