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

Abstract

Second-generation antipsychotics may have few advantages over older, cheaper drugs, except for possibly reduced risk of tardive dyskinesia. To evaluate the cost-effectiveness of second-generation antipsychotics with regard to reducing tardive dyskinesia. Literature 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. Estimating 0.143 QALYs lost per case of severe tardive dyskinesia, 1-year cost-effectiveness cumulative estimates ranged from pounds 74,000 (dollars 149,000) to pounds 342,000 (dollars 683,000) per QALY, all above the conventional policy threshold of pounds 25,000 (dollars 50,000). Reduction of tardive dyskinesia with second-generation antipsychotics appears unlikely to meet standards for cost-effectiveness.