Evaluating the cost-effectiveness of reduced tardive dyskinesia with second-generation antipsychotics

Abstract

BackgroundSecond-generation antipsychotics may have few advantages over older, cheaper drugs, except for possibly reduced risk of tardive dyskinesia.AimsTo evaluate the cost-effectiveness of second-generation antipsychotics with regard to reducing tardive dyskinesia.MethodLiterature was reviewed on risk of tardive dyskinesia with second-generation antipsychotics; on severity duration and impairment of tardive dyskinesia; and on the relationship of this disorder to quality of life and quality-adjusted life-years (QALYs). Diverse cost and benefit assumptions and of 1-year and 5-year planning horizons were examined in a deterministic sensitivity analysis.ResultsEstimating 0.143 QALYs lost per case of severe tardive dyskinesia, 1-year cost-effectiveness estimates for second-generation antipsychotics ranged from $185 000 ($370 000) to $850 000 ($1.7 million) per QALY, and 5-year cumulative estimates ranged from $74 000 ($ 149 000) to $342 000 ($683 000) per QALY, all above the conventional policy threshold of $25 000 ($50 000).ConclusionsReduction of tardive dyskinesia with second-generation antipsychotics appears unlikely to meet standards for cost-effectiveness.