Effectiveness and Cost of Olanzapine and Haloperidol in the Treatment of Schizophrenia

A Randomized Controlled Trial

Robert Rosenheck, Deborah Perlick, Stephen Bingham, Wen Liu-Mares, Joseph Collins, Stuart Warren, Douglas Leslie, Edward Allan, E. Cabrina Campbell, Stanley Caroff, June Corwin, Lori Davis, Richard Douyon, Lawrence Dunn, Denise Evans, Ede Frecska, John Grabowski, David Graeber, Lawrence Herz, Kong Kwon & 5 others William Lawson, Felicitas Mena, Javaid Sheikh, David Smelson, Valerie Smith-Gamble

Research output: Contribution to journalArticle

305 Citations (Scopus)

Abstract

Context: Although olanzapine has been widely adopted as a treatment of choice for schizophrenia, its long-term effectiveness and costs have not been evaluated in a controlled trial in comparison with a standard antipsychotic drug. Objective: To evaluate the effectiveness and cost impact of olanzapine compared with haloperidol in the treatment of schizophrenia. Design and Setting: Double-blind, randomized controlled trial with randomization conducted between June 1998 and June 2000 at 17 US Department of Veterans Affairs medical centers. Participants: Three hundred nine patients with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of schizophrenia or schizoaffective disorder, serious symptoms, and serious dysfunction for the previous 2 years. Fifty-nine percent fully completed and 36% partially completed follow-up assessments. Interventions: Patients were randomly assigned to receive flexibly dosed olanzapine, 5 to 20 mg/d, with prophylactic benztropine, 1 to 4 mg/d (n = 159); or haloperidol, 5 to 20 mg/d (n=150), for 12 months. Main Outcome Measures: Standardized measures of symptoms, quality of life, neurocognitive status, and adverse effects of medication. Veterans Affairs administrative data and interviews concerning non-VA service use were used to estimate costs from the perspective of the VA health care system and society as a whole (ie, consumption of all resources on behalf of these patients). Results: There were no significant differences between groups in study retention; positive, negative, or total symptoms of schizophrenia; quality of life; or extrapyramidal symptoms. Olanzapine was associated with reduced akathisia in the intention-to-treat analysis (P<.001) and with lower symptoms of tardive dyskinesia in a secondary analysis including only observations during blinded treatment with study drug. Small but significant advantages were also observed on measures of memory and motor function. Olanzapine was also associated with more frequent reports of weight gain and significantly greater VA costs, ranging from $3000 to $9000 annually. Differences in societal costs were somewhat smaller and were not significant. Conclusion: Olanzapine does not demonstrate advantages compared with haloperidol (in combination with prophylactic benztropine) in compliance, symptoms, extrapyramidal symptoms, or overall quality of life, and its benefits in reducing akathisia and improving cognition must be balanced with the problems of weight gain and higher cost.

Original languageEnglish
Pages (from-to)2693-2702
Number of pages10
JournalJournal of the American Medical Association
Volume290
Issue number20
DOIs
Publication statusPublished - 26 Nov 2003
Externally publishedYes

Fingerprint

olanzapine
Haloperidol
Cost-Benefit Analysis
Schizophrenia
Randomized Controlled Trials
Benztropine
Costs and Cost Analysis
Psychomotor Agitation
Quality of Life
Weight Gain
Therapeutics
United States Department of Veterans Affairs
Intention to Treat Analysis
Veterans
Random Allocation
Diagnostic and Statistical Manual of Mental Disorders
Psychotic Disorders
Cognition
Antipsychotic Agents
Compliance

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Rosenheck, R., Perlick, D., Bingham, S., Liu-Mares, W., Collins, J., Warren, S., ... Smith-Gamble, V. (2003). Effectiveness and Cost of Olanzapine and Haloperidol in the Treatment of Schizophrenia: A Randomized Controlled Trial. Journal of the American Medical Association, 290(20), 2693-2702. https://doi.org/10.1001/jama.290.20.2693

Effectiveness and Cost of Olanzapine and Haloperidol in the Treatment of Schizophrenia : A Randomized Controlled Trial. / Rosenheck, Robert; Perlick, Deborah; Bingham, Stephen; Liu-Mares, Wen; Collins, Joseph; Warren, Stuart; Leslie, Douglas; Allan, Edward; Campbell, E. Cabrina; Caroff, Stanley; Corwin, June; Davis, Lori; Douyon, Richard; Dunn, Lawrence; Evans, Denise; Frecska, Ede; Grabowski, John; Graeber, David; Herz, Lawrence; Kwon, Kong; Lawson, William; Mena, Felicitas; Sheikh, Javaid; Smelson, David; Smith-Gamble, Valerie.

In: Journal of the American Medical Association, Vol. 290, No. 20, 26.11.2003, p. 2693-2702.

Research output: Contribution to journalArticle

Rosenheck, R, Perlick, D, Bingham, S, Liu-Mares, W, Collins, J, Warren, S, Leslie, D, Allan, E, Campbell, EC, Caroff, S, Corwin, J, Davis, L, Douyon, R, Dunn, L, Evans, D, Frecska, E, Grabowski, J, Graeber, D, Herz, L, Kwon, K, Lawson, W, Mena, F, Sheikh, J, Smelson, D & Smith-Gamble, V 2003, 'Effectiveness and Cost of Olanzapine and Haloperidol in the Treatment of Schizophrenia: A Randomized Controlled Trial', Journal of the American Medical Association, vol. 290, no. 20, pp. 2693-2702. https://doi.org/10.1001/jama.290.20.2693
Rosenheck, Robert ; Perlick, Deborah ; Bingham, Stephen ; Liu-Mares, Wen ; Collins, Joseph ; Warren, Stuart ; Leslie, Douglas ; Allan, Edward ; Campbell, E. Cabrina ; Caroff, Stanley ; Corwin, June ; Davis, Lori ; Douyon, Richard ; Dunn, Lawrence ; Evans, Denise ; Frecska, Ede ; Grabowski, John ; Graeber, David ; Herz, Lawrence ; Kwon, Kong ; Lawson, William ; Mena, Felicitas ; Sheikh, Javaid ; Smelson, David ; Smith-Gamble, Valerie. / Effectiveness and Cost of Olanzapine and Haloperidol in the Treatment of Schizophrenia : A Randomized Controlled Trial. In: Journal of the American Medical Association. 2003 ; Vol. 290, No. 20. pp. 2693-2702.
@article{142a2b20dd19477e80fc7ee3effde8f2,
title = "Effectiveness and Cost of Olanzapine and Haloperidol in the Treatment of Schizophrenia: A Randomized Controlled Trial",
abstract = "Context: Although olanzapine has been widely adopted as a treatment of choice for schizophrenia, its long-term effectiveness and costs have not been evaluated in a controlled trial in comparison with a standard antipsychotic drug. Objective: To evaluate the effectiveness and cost impact of olanzapine compared with haloperidol in the treatment of schizophrenia. Design and Setting: Double-blind, randomized controlled trial with randomization conducted between June 1998 and June 2000 at 17 US Department of Veterans Affairs medical centers. Participants: Three hundred nine patients with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of schizophrenia or schizoaffective disorder, serious symptoms, and serious dysfunction for the previous 2 years. Fifty-nine percent fully completed and 36{\%} partially completed follow-up assessments. Interventions: Patients were randomly assigned to receive flexibly dosed olanzapine, 5 to 20 mg/d, with prophylactic benztropine, 1 to 4 mg/d (n = 159); or haloperidol, 5 to 20 mg/d (n=150), for 12 months. Main Outcome Measures: Standardized measures of symptoms, quality of life, neurocognitive status, and adverse effects of medication. Veterans Affairs administrative data and interviews concerning non-VA service use were used to estimate costs from the perspective of the VA health care system and society as a whole (ie, consumption of all resources on behalf of these patients). Results: There were no significant differences between groups in study retention; positive, negative, or total symptoms of schizophrenia; quality of life; or extrapyramidal symptoms. Olanzapine was associated with reduced akathisia in the intention-to-treat analysis (P<.001) and with lower symptoms of tardive dyskinesia in a secondary analysis including only observations during blinded treatment with study drug. Small but significant advantages were also observed on measures of memory and motor function. Olanzapine was also associated with more frequent reports of weight gain and significantly greater VA costs, ranging from $3000 to $9000 annually. Differences in societal costs were somewhat smaller and were not significant. Conclusion: Olanzapine does not demonstrate advantages compared with haloperidol (in combination with prophylactic benztropine) in compliance, symptoms, extrapyramidal symptoms, or overall quality of life, and its benefits in reducing akathisia and improving cognition must be balanced with the problems of weight gain and higher cost.",
author = "Robert Rosenheck and Deborah Perlick and Stephen Bingham and Wen Liu-Mares and Joseph Collins and Stuart Warren and Douglas Leslie and Edward Allan and Campbell, {E. Cabrina} and Stanley Caroff and June Corwin and Lori Davis and Richard Douyon and Lawrence Dunn and Denise Evans and Ede Frecska and John Grabowski and David Graeber and Lawrence Herz and Kong Kwon and William Lawson and Felicitas Mena and Javaid Sheikh and David Smelson and Valerie Smith-Gamble",
year = "2003",
month = "11",
day = "26",
doi = "10.1001/jama.290.20.2693",
language = "English",
volume = "290",
pages = "2693--2702",
journal = "JAMA - Journal of the American Medical Association",
issn = "0002-9955",
publisher = "American Medical Association",
number = "20",

}

TY - JOUR

T1 - Effectiveness and Cost of Olanzapine and Haloperidol in the Treatment of Schizophrenia

T2 - A Randomized Controlled Trial

AU - Rosenheck, Robert

AU - Perlick, Deborah

AU - Bingham, Stephen

AU - Liu-Mares, Wen

AU - Collins, Joseph

AU - Warren, Stuart

AU - Leslie, Douglas

AU - Allan, Edward

AU - Campbell, E. Cabrina

AU - Caroff, Stanley

AU - Corwin, June

AU - Davis, Lori

AU - Douyon, Richard

AU - Dunn, Lawrence

AU - Evans, Denise

AU - Frecska, Ede

AU - Grabowski, John

AU - Graeber, David

AU - Herz, Lawrence

AU - Kwon, Kong

AU - Lawson, William

AU - Mena, Felicitas

AU - Sheikh, Javaid

AU - Smelson, David

AU - Smith-Gamble, Valerie

PY - 2003/11/26

Y1 - 2003/11/26

N2 - Context: Although olanzapine has been widely adopted as a treatment of choice for schizophrenia, its long-term effectiveness and costs have not been evaluated in a controlled trial in comparison with a standard antipsychotic drug. Objective: To evaluate the effectiveness and cost impact of olanzapine compared with haloperidol in the treatment of schizophrenia. Design and Setting: Double-blind, randomized controlled trial with randomization conducted between June 1998 and June 2000 at 17 US Department of Veterans Affairs medical centers. Participants: Three hundred nine patients with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of schizophrenia or schizoaffective disorder, serious symptoms, and serious dysfunction for the previous 2 years. Fifty-nine percent fully completed and 36% partially completed follow-up assessments. Interventions: Patients were randomly assigned to receive flexibly dosed olanzapine, 5 to 20 mg/d, with prophylactic benztropine, 1 to 4 mg/d (n = 159); or haloperidol, 5 to 20 mg/d (n=150), for 12 months. Main Outcome Measures: Standardized measures of symptoms, quality of life, neurocognitive status, and adverse effects of medication. Veterans Affairs administrative data and interviews concerning non-VA service use were used to estimate costs from the perspective of the VA health care system and society as a whole (ie, consumption of all resources on behalf of these patients). Results: There were no significant differences between groups in study retention; positive, negative, or total symptoms of schizophrenia; quality of life; or extrapyramidal symptoms. Olanzapine was associated with reduced akathisia in the intention-to-treat analysis (P<.001) and with lower symptoms of tardive dyskinesia in a secondary analysis including only observations during blinded treatment with study drug. Small but significant advantages were also observed on measures of memory and motor function. Olanzapine was also associated with more frequent reports of weight gain and significantly greater VA costs, ranging from $3000 to $9000 annually. Differences in societal costs were somewhat smaller and were not significant. Conclusion: Olanzapine does not demonstrate advantages compared with haloperidol (in combination with prophylactic benztropine) in compliance, symptoms, extrapyramidal symptoms, or overall quality of life, and its benefits in reducing akathisia and improving cognition must be balanced with the problems of weight gain and higher cost.

AB - Context: Although olanzapine has been widely adopted as a treatment of choice for schizophrenia, its long-term effectiveness and costs have not been evaluated in a controlled trial in comparison with a standard antipsychotic drug. Objective: To evaluate the effectiveness and cost impact of olanzapine compared with haloperidol in the treatment of schizophrenia. Design and Setting: Double-blind, randomized controlled trial with randomization conducted between June 1998 and June 2000 at 17 US Department of Veterans Affairs medical centers. Participants: Three hundred nine patients with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of schizophrenia or schizoaffective disorder, serious symptoms, and serious dysfunction for the previous 2 years. Fifty-nine percent fully completed and 36% partially completed follow-up assessments. Interventions: Patients were randomly assigned to receive flexibly dosed olanzapine, 5 to 20 mg/d, with prophylactic benztropine, 1 to 4 mg/d (n = 159); or haloperidol, 5 to 20 mg/d (n=150), for 12 months. Main Outcome Measures: Standardized measures of symptoms, quality of life, neurocognitive status, and adverse effects of medication. Veterans Affairs administrative data and interviews concerning non-VA service use were used to estimate costs from the perspective of the VA health care system and society as a whole (ie, consumption of all resources on behalf of these patients). Results: There were no significant differences between groups in study retention; positive, negative, or total symptoms of schizophrenia; quality of life; or extrapyramidal symptoms. Olanzapine was associated with reduced akathisia in the intention-to-treat analysis (P<.001) and with lower symptoms of tardive dyskinesia in a secondary analysis including only observations during blinded treatment with study drug. Small but significant advantages were also observed on measures of memory and motor function. Olanzapine was also associated with more frequent reports of weight gain and significantly greater VA costs, ranging from $3000 to $9000 annually. Differences in societal costs were somewhat smaller and were not significant. Conclusion: Olanzapine does not demonstrate advantages compared with haloperidol (in combination with prophylactic benztropine) in compliance, symptoms, extrapyramidal symptoms, or overall quality of life, and its benefits in reducing akathisia and improving cognition must be balanced with the problems of weight gain and higher cost.

UR - http://www.scopus.com/inward/record.url?scp=0345293130&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0345293130&partnerID=8YFLogxK

U2 - 10.1001/jama.290.20.2693

DO - 10.1001/jama.290.20.2693

M3 - Article

VL - 290

SP - 2693

EP - 2702

JO - JAMA - Journal of the American Medical Association

JF - JAMA - Journal of the American Medical Association

SN - 0002-9955

IS - 20

ER -