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The usefulness and use of second-generation - page 19 / 81





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Three studies examined an acute intramuscular formulation of ziprasidone in acutely agitated, psychotic patients, prior to transition to oral ziprasidone. All found intramuscular ziprasidone to be rapidly effective and well tolerated at therapeutic doses, extrapyramidal motor dysfunctions being conspicuously absent [63].  Excessive sedation was also not reported.


Hwang et al. [64] reported the results of a randomized double-blind, 6-week trial of zotepine and haloperidol in 70 patients with schizophrenia who had positive symptoms. Both treatments were equivalent in their reduction of symptoms:  zotepine produced fewer  EPSs but was associated with more dizziness, weight gain and increases in pulse rate than haloperidol-treated patients.

Economic data

SGAMs offer patients, families and clinicians well-tolerated, effective treatments [1].  Although there is now sufficient evidence on the comparative efficacy of the SGAMs and conventional drugs to make meta-analyses possible, there are still few good cost-effectiveness or similar studies, and many of the published economic comparisons between FGAMs and SGAMs have been criticized for methodological weaknesses [182-183].  A number of the earlier studies were discussed in the Technical Review [181].

The wide-ranging economic impact of schizophrenia continues to be reported in both longitudinal (Table 1) and cross-sectional studies (e.g. [184-186]. Yet almost all of the cost-effectiveness studies on schizophrenia treatment have focused on the important but narrow comparison of health-care impacts (on the cost side) and symptom/functioning changes (on the effectiveness side). Wider cost measures, assessment of patients’ quality of life, and an understanding of family impacts are needed in order to gauge the full consequences of treatment with SGAMs.

Cost-effectiveness evidence

New evidence on the cost-effectiveness of clozapine compared to usual care with standard neuroleptic therapy is offered by Essock et al. [187] from a randomized open-label study of patients in three large Connecticut state hospitals. Treatment-resistant  schizophrenia patients who had been hospitalised for at least 4 months (and who had spent at least  2 years in hospital in the previous 5  years) were eligible for the trial. Data were collected every 4 months, over a 2-year period, on the initial sample of 138 patients. There were no differences in the rates of discharge from hospital, but, once discharged, members of the clozapine group were less likely to be readmitted. Clozapine patients were significantly less disruptive, required fewer ‘as-needed’ antipsychotic medications, and experienced significantly fewer EPSs than the usual care group. There were no differences between the groups with respect to weight gain or Brief Psychiatric Rating Scale.  Compared to the usual-care group, the clozapine sample had US$1112 higher costs in the first year after randomization, but US$7149 lower costs in the second year. These differences (and their sum) did not reach

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