Impact of Atypical Antipsychotics on Outcomes of Care in Schizophrenia

Objective: To compare persistence, compliance, and psychiatric treatment costs in patients who were initiated on atypical antipsychotics. Methods: Medical and pharmacy claims data were used to compare persistence (days of therapy between first and last prescriptions, allowing therapy gaps <90 days); compliance (ratio of days of medication supplied to total days on therapy); treatment costs in adults with schizophrenia having claims for atypical antipsychotics from March 2001 to August 2003; and enrollment for ≥6 months before and ≥12 months after therapy initiation. Psychiatric treatment costs for 1 year were examined before and after therapy initiation. Differences in costs were tested by univariate analyses. Results: Persistence was approximately 30 days longer for patients receiving ziprasidone (n = 217; 228 days) than risperidone (n = 831; 193 days) or olanzapine (n = 762; 201 days). Compliance was significantly (P <.05) higher among patients receiving ziprasidone (87%) compared with other treatments (78%-80%). Ziprasidone patients had significantly larger decreases (‐$6866) in mean annual psychiatric-related costs following therapy initiation than those on risperidone (‐$3353; P = .0116) or olanzapine (‐$4764; P = .0021). The primary driver of cost savings was reduced hospitalization after treatment initiation. Conclusion: Patients initiated on ziprasidone had longer persistence, better compliance, and greater decreases in psychiatric-related costs than those initiated on other atypicals. (Am J Manag Care. 2005;11:S254-S261)