In a world of rising health care costs, the costs of medications account for a disproportionate share of the increase. This year alone, the cost of antipsychotic drugs is expected to increase to over $10 billion - 80 percent of which is paid by the public sector.
As a nation, we save money when people take their prescribed antipsychotic medication. Two ongoing studies are now trying to gauge the relative effectiveness of medications used to treat schizophrenia and depression. However, these studies also raise the specter of restricting psychiatric drugs in state and federal budgets, or replacing them with cheaper, older generation medications.
Both of the studies are sponsored by the National Institute of Mental Health (NIMH) using data gathered directly from patients and their doctors.
Phase I of this three phase study was released on September 22, 2005 in the New England Journal of Medicine. CATIE researchers compared discontinuation rates with four atypical antipsychotic drugs and one older conventional antipsychotic medication. The new atypical medications, representing 90 percent of the market, cost approximately ten times older conventional antipsychotic medications. The study found that old and new medications are comparably effective, but both are associated with a high rate of discontinuation by consumers due to side effects or incomplete control of symptoms.
Although older medications performed as well as newer medications, the study noted that based on previous research, newer medications are better at reducing negative symptoms (e.g., lack of emotion, interest, and expression). "For many Americans living with schizophrenia, newer generation medications have made the difference in level of recovery," said NAMI medical director Ken Duckworth. "For each person, the choice of medication must be made carefully. Different medications have different side-effects. They are not interchangeable."
Future phases of the CATIE study will address predictors of response, cost-effectiveness, outcomes and quality of life.
Another study, STAR*D, whose first phase findings were released January 1, 2006, is designed to provide the first large-scale analysis of various depression treatments in real-life settings. The trial, the largest of its kind, lasted for 6 years, and allowed researchers to track individuals who became symptom-free following treatment and to identify those with treatment-resistant depression.
Of the almost 3,000 adults who participated in the study, one third experienced a full remission within weeks after beginning to take an antidepressant medication, while another 15 percent experienced some improvement. The goal of STAR*D is to assess the effectiveness of adequately delivered treatments in real world patients with major depressive disorder.
The final goal of STAR*D is to prepare protocols for use in routine practice that will allow clinicians to better treat individuals with major depressive disorder by creating more personalized treatment.
The remaining phases of the study are set to be released later this summer.
Read more about STAR*D
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