Implications for Decision Making
Differences exist among atypical antipsychotics. The available evidence suggests that, compared with risperidone, olanzapine is associated with a lower risk of relapse and of treatment discontinuation, but is less well tolerated. Evidence also shows that clozapine use reduces suicide risk in high-risk patients, compared with olanzapine.
Costs to the health care system do not reflect differences in utilization costs. Generic and brand-name olanzapine will require a larger investment by drug plans than quetiapine and risperidone. These costs are offset by reduced downstream costs from hospitalization, the largest cost component for treating patients with schizophrenia.
Decisions should be revisited. The lack of high-quality evidence to inform first-line therapy reimbursement decisions suggests that additional analysis should be undertaken when comparative effectiveness studies are available. The costs associated with polytherapy, long-term treatment, and the role of traditional antipsychotics should be considered.