Hargreaves William A, Gibson P Joseph
University of California, San Francisco, California, USA.
CNS Drugs. 2005;19(5):393-410. doi: 10.2165/00023210-200519050-00003.
Risperidone and olanzapine are novel antipsychotic medications that compete as first-line agents in treating patients with schizophrenia. The objective of this paper is to review the available evidence regarding the effectiveness and cost of risperidone versus olanzapine. We reviewed both randomised and peer-reviewed non-randomised head-to-head (olanzapine versus risperidone) studies in populations with schizophrenia. The studies were selected through a MEDLINE search. Risperidone and olanzapine provide control of positive, negative and global symptoms of schizophrenia. Each drug has a distinct adverse effect profile. Five randomised trials comparing risperidone with olanzapine suggested grossly similar efficacy in the first 2 months of treatment, with some results indicating advantages for olanzapine over the longer term. Only two of the trials included measures of service utilisation. One had 28-week follow-up, and the other followed patients for 12 months but had small sample sizes. Both experimental and naturalistic studies indicated that the acquisition cost of olanzapine is about 50% greater than for risperidone at dose levels commonly used for the treatment of schizophrenia. The only experiment with 12-month total treatment cost data found essentially equivalent costs for patients assigned to olanzapine or risperidone, showing that there are circumstances where total cost is similar in spite of the higher drug acquisition cost of olanzapine. Most retrospective studies also reported comparable total cost. Few studies gave enough information to evaluate cost effectiveness. The clear difference in acquisition cost of these two medications was rarely reflected in overall treatment cost in the studies we reviewed. Overall, our review of the literature highlights that there is inadequate evidence to distinguish the relative total cost of care associated with risperidone versus olanzapine, although accumulating evidence suggests the difference is small. This population-based conclusion does not indicate which medication is more costly or more cost effective for a particular patient; this depends on each patient's response to each medication.
利培酮和奥氮平是新型抗精神病药物，在治疗精神分裂症患者时作为一线药物相互竞争。本文的目的是综述关于利培酮与奥氮平的有效性和成本的现有证据。我们回顾了针对精神分裂症患者群体的随机和同行评审的非随机头对头（奥氮平与利培酮）研究。这些研究是通过MEDLINE搜索选定的。利培酮和奥氮平可控制精神分裂症的阳性、阴性和整体症状。每种药物都有独特的不良反应谱。五项比较利培酮与奥氮平的随机试验表明，在治疗的前两个月疗效大致相似，一些结果表明从长期来看奥氮平更具优势。只有两项试验纳入了服务利用指标。一项试验有28周的随访，另一项试验对患者随访了12个月，但样本量较小。实验性研究和观察性研究均表明，在治疗精神分裂症常用剂量水平下，奥氮平的购置成本比利培酮高约50%。唯一一项有12个月总治疗成本数据的试验发现，分配接受奥氮平或利培酮治疗的患者成本基本相当，这表明尽管奥氮平的药物购置成本较高，但在某些情况下总成本是相似的。大多数回顾性研究也报告了相当的总成本。很少有研究提供足够信息来评估成本效益。在我们综述的研究中，这两种药物购置成本的明显差异很少反映在总体治疗成本中。总体而言，我们对文献的综述强调，虽然越来越多的证据表明差异很小，但仍缺乏足够证据来区分与利培酮和奥氮平相关的相对总护理成本。这个基于群体的结论并未表明哪种药物对特定患者更昂贵或更具成本效益；这取决于每个患者对每种药物的反应。
