Cost-effectiveness of olanzapine vs. aripiprazole in the treatment of schizophrenia
Haya Ascher‐SvanumMichael D. StenslandXiaomei PengDouglas E. FariesVirginia L. StaufferOlawale OsuntokunJohn M. Kane
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Objective:Information about the cost-effectiveness of aripiprazole relative to other atypical antipsychotics in the treatment of patients with schizophrenia is limited. This information is needed to better inform drug formulary managers and population-based health care decision makers. The objective of this study was to compare the cost-effectiveness of olanzapine to aripiprazole in the treatment of schizophrenia from the perspective of public payers in the United States.Methods:Data for this post-hoc analysis came from a 28-week double-blind, randomized trial of individuals with schizophrenia who were treated with olanzapine or aripiprazole (clinicaltrial.gov identifier NCT00088049). Two-thirds (67.7%) of the patients were male and the patients' mean age was 37.6 years. Utilities were calculated based on previously published methods using the Positive and Negative Syndrome Scale (PANSS) and treatment-emergent adverse events. Treatment costs were calculated based on previously published methods and were inflated to 2008 US dollars. A mixed model was used to compare outcomes on utilities. Propensity score-adjusted analysis of covariance was used for the cost analysis.Results:Olanzapine treatment was associated with statistically significantly greater total utility scores relative to aripiprazole (0.78 vs. 0.76; p = 0.024) and lower total treatment costs ($22,831 vs. $24,749; p = 0.013), although medication acquisition cost was significantly higher for olanzapine than aripiprazole ($3524 vs. $2637; p < 0.001). An incremental cost-effectiveness ratio was not calculated because olanzapine was found to be the dominant choice (i.e., greater effectiveness and lower total costs).Conclusions:This cost-effectiveness analysis is the first to use patient-level data from a randomized, double-blind study comparing olanzapine and aripiprazole in the treatment of patients with schizophrenia. Olanzapine was found to be a dominant cost-effective choice, as it was associated with greater effectiveness at lower total costs relative to aripiprazole.Keywords:
Aripiprazole
To report a case in which a patient tolerated and responded to high-dose aripiprazole and lost weight after having been on olanzapine for several years; a secondary objective is to discuss the use of aripiprazole dosages at higher than those recommended in the product's labeling.A 57-year-old man with a 30 year history of schizophrenia had been taking olanzapine for 4 years, with the dosage titrated to 20 mg/day, to control the psychosis. After he had gained significant weight with olanzapine (the highest was 102.7 kg), his treatment was switched to aripiprazole. The patient required a high dose of aripiprazole (60 mg/day) to achieve full control of the psychiatric symptoms, and during aripiprazole therapy, he lost the weight he had gained while on olanzapine, weighing 85.9 kg within 7 months after the therapy switch.Dosages of atypical antipsychotics higher than those recommended by the Food and Drug Administration are often used in clinical practice for refractory patients, despite the lack of evidence. The literature available on this subject is limited to small, double-blind trials; open-label trials; and case reports. Although certain patients may benefit from higher doses of atypical antipsychotics, the lack of evidence limits their use.High-dose aripiprazole (60 mg/day) was well tolerated and controlled this patient's symptoms effectively. In addition, he lost weight that was gained while being treated with olanzapine. High-dose aripiprazole may be beneficial and safe in refractory patients; however, large, double-blind, randomized clinical trials are needed.
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Objective To determine whether the prescription of aripiprazole, compared with olanzapine and haloperidol, was associated with a lower frequency of metabolic syndrome ( MS ) and treatment discontinuation at 1 year. Method Patients were randomly assigned to be treated open‐label and according to usual clinical practice with either aripiprazole, olanzapine, or haloperidol and followed up for 1 year. Results Three hundred out‐patients with persistent schizophrenia were recruited in 35 mental health services. The intention‐to‐treat (ITT) analysis found no significant differences in the rate of MS between aripiprazole (37%), olanzapine (47%), and haloperidol (42%). Treatment discontinuation for any cause was higher for aripiprazole (52%) than for olanzapine (33%; OR , 0.41; P = 0.004), or haloperidol (37%; OR , 0.51; P = 0.030). No significant difference was found between olanzapine and haloperidol. Time to discontinuation for any cause was longer for olanzapine than for aripiprazole ( HR , 0.55; P < 0.001). No significant differences were found between haloperidol and aripiprazole, or between olanzapine and haloperidol. Conclusion The prescription of aripiprazole did not significantly reduce the rates of MS , but its treatment retention was worse. Aripiprazole cannot be considered the safest and most effective drug for maintenance treatment of schizophrenia in routine care, although it may have a place in antipsychotic therapy.
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Objective: To compare the efficacy and safety of olanzapine and aripiprazole in the treatment of schizophrenia. Method:100 patients were randomly assigned to olanzapine group or aripiprazole group respectively for 8 weeks.The positive and negative symptom scale(PANSS) and clinical global impressions-severity of illness rating scale(CGI-SI) were used to measure the efficacy;the treatment emergent symptom scale(TESS) was used to measure side effects. Results:Marked improvement rate of olanzapine group was 76.0%,and aripiprazole group was 72.0%,the efficacy was similar in two groups(P0.05);side effects of olanzapine were drowsiness,increase of body weight and blood pressure,which were obviously more frequent than in aripiprazole(P0.01);the main side effects of aripiprazole were extrapyramidal side effects and insomnia or excitement,which were more frequent than those in olanzapine group(P0.01). Conclusion: Olanzapine had similar effects to aripiprazole in the treatment of schizophrenia.They have high safety.
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Objective:To study the clinical efficacy and side effects of olanzapine and aripiprazole in the treatment of refractory schizophrenic patients. Methods:A total of 70 patients with refractory schizophrenic were randomly divided into two groups ,respectively,for olanzapine and aripiprazole treatment, treatment for 12 weeks,with Positive Symptoms and Negative Symptoms Scale(PANSS) assessment of efficacy,adverse reactions with the scale (TESS) assessment of adverse reactions.Results: Olanzapine in the treatment response rate was62.9 %, aripiprazole 60%,overall efficacy difference between the two groups was not statistically significant (p0.05).The side effects of olanzapine were increased weight and blood glucose levels, The side effects of aripiprazole were insomnia and headache.Conclusions: Olanzapine and aripiprazole are similar in the treatment of refractory schizophrenic,with fewer side effects.
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*Department of Psychiatry, Taipei Medical University-Wan Fang Hospital, †Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital Taipei, Taiwan [email protected]
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[Objective] To explore the effect of switching patients who had gained excessive weight and stable psychiatry on Olanzapine to Aripiprazole, with assessments of safety and continued efficacy as well as weight change. [Methods] 24 patients who psychiatrically stable on Olanzapine (PANSS60) but had gained ≥20% in weight or had body mass index ≥25.0 kg/m2 were switched to Aripiprazole over a 4-week period and followed for 12 weeks, the total study duration being 16 weeks. Clinical assessments included weight change, BMI, antipsychotic efficacy using the Positive and Negative Symptom Syndrome Scale (PANSS), adverse events using the TESS Scale, and laboratory studies for metabolic measures. [Results] There were significant changes in weight loss, body mass index (BMI), waist circumference, fasting blood glucose (FBG), and total cholesterol (TG) after switching from Olanzapine to Aripiprazole for 16 weeks (P 0.01 or P 0.05). There were no significant changes in PANSS total scores, TESS scores or the other metabolic parameters. [Conclusion] Switching patients to Aripiprazole, appears to be a effective strategy for managing Olanzapine induced weight gain and metabolic disorder.
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Objective To probe clinical effect,tolerance and safety of olanzapine and aripiprazole for senile dementia on maniac access. Methods 42 patients with senile dementia on maniac access collected in our hospital from January 2009 to June 2011 were divided randomly aripiprazole group,olanzapine group,combined treatment group(olanzapine and aripiprazole).Every group was 14 patients.The clinical effect and side-effects of three groups were observed and evaluated after 8 weeks. Results The total effective rate and side-effects incidence in combined treatment group were better than those in the other two groups. There were no significant difference in the total effective rate and side-effects incidence between aripiprazole group with olanzapine group. Conclusion There were significant effect and low side-effects on olanzapine and aripiprazole for senile dementia on maniac access.
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Objective:To explore effect difference of Olanzapine and Aripiprazole on lipid metabolism in patients with first-episode schizophrenia. Methods:127 patients with the first-episode schizophrenia were randomly divided into Olanzapine group(n =63) and Aripiprazole group(n = 64). The levels of total cholesterol(TC) and triglyceride(TG) were measured before and 8 weeks after the treatment. Results:8 weeks after the treatment,the TC and TG levels of Olanzapine group increased significantly(P 0. 05 or P 0. 01); but Aripiprazole group had less effects on the blood lipid(P 0. 05). Conclusions:The treatment of Olanzapine may cause abnormal blood lipid level. It is necessary to take preventive measures and test the blood lipid level in schizophrenic patients treated with Olanzapine. But Aripiprazole has fewer side effects on lipid metabolism than Olanzapine.
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Article AbstractObjective: To evaluate the effectiveness of olanzapine versus aripiprazole in patients with schizophrenia. Method: Patients aged 18 to 65 years with schizophrenia (diagnosed according to DSM-IV-TR criteria) were randomly assigned to either olanzapine (n = 281) or aripiprazole (n = 285) for 28 weeks of double-blind treatment. The primary outcome was time to all-cause discontinuation. Efficacy was measured by Positive and Negative Syndrome Scale (PANSS) total change from baseline. Time-to-event data were analyzed via the Kaplan-Meier method. The study was conducted from October 2003 to July 2007.Results: Treatment groups did not differ significantly in time to all-cause discontinuation (p =.067) or all-cause discontinuation rate (olanzapine, 42.7% vs. aripiprazole, 50.2%; p =.053). Olanzapine-treated patients had significantly longer time to efficacy-related discontinuation (p < 100 mg/dL and ≥ 126 mg/dL at any time was 1.7% for olanzapine and 0.6% for aripiprazole (p =.623). Fasting mean total cholesterol change was +4.09 mg/dL for olanzapine and -9.85 mg/dL for aripiprazole (p < 200 mg/dL and ≥ 240 mg/dL at any time was 9.2% for olanzapine and 1.5% for aripiprazole (p =.008). Fasting mean triglycerides change was +25.66 mg/dL for olanzapine and -17.52 mg/dL for aripiprazole (p Conclusion: Treatment groups did not differ significantly on the primary outcome. Olanzapine-treated patients had significantly greater improvement in symptom efficacy at 28 weeks as well as significantly greater mean increases in weight and glucose and significantly greater worsening on lipids parameters.Trial Registration: clinicaltrials.gov Identifier: NCT00088049
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