Cost-Consequence of Diabetes and Coronary Heart Disease in Patients with Schizophrenia in Germany - a Social and Health Insurance Perspective

OBJECTIVE: To determine the risk and associated cost-consequences for diabetes and coronary heart disease (CHD) among schizophrenic patients treated by different atypical antipsychotics. METHODS: Validated general population risk prediction models (Stern and Framingham model) were used to derive individual patient risks based on 26 weeks follow-up from the real-life STAR study for a 7.5 year (diabetes) and 10 year (CHD) time period. Standard of care was compared to a more favourable antipsychotic treatment regarding metabolic side effects, here shown for aripiprazole. Associated risks and costs compared to standard of care were estimated. RESULTS: For the time horizon investigated the overall excess risk in a hypothetical cohort of 1000 patients treated with antipsychotic standard of care was 23 to 48 additional diabetes cases (number needed to treat [NNT] 21 - 43) and 3.9 cases of CHD events (NNT 256) as compared to a more favourable metabolic profile. This translates into avoidable total costs for Germany of approximately 50 million € per year for diabetes and 70 million € per year for CHD at the end of the prediction period. This includes direct costs per year of 32 million € for diabetes and 16 million € for CHD. Due to the long-term risks of disease those costs are time dependent: the avoidable direct costs increase from today approximately 1 % to approx. 9 % of total medication costs for schizophrenia in Germany. CONCLUSION: Current antipsychotic standard of care leads to a clinically significant number of long-term diabetes and CHD cases in patients with schizophrenia. This and associated costs might be avoided by prescribing antipsychotics with a favorable metabolic profile such as aripiprazole.