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Risperidone, Haloperidol and Clozapine in the South Carolina Medicaid Program

A Comparative Analysis of Utilisation and Expenditure

  • Original Research Article
  • Published:
Disease Management and Health Outcomes

Abstract

Objective: To determine whether the increased acquisition costs associated with the atypical antipsychotic risperidone are offset by reductions in other mental health care utilisation and expenditure.

Design and setting: The study was population-based and used South Carolina Medicaid claims data to determine changes in mental healthcare utilisation and expenditures related to schizophrenia. Changes in mental health—related utilisation and expenditures over time were calculated; total mental health—related expenditures and utilisation were disaggregated into pharmaceuticals, inpatient hospitalisations, and ambulatory and inpatient physician services [Health Care Financing Administration (HCFA) 1500 claims]. Groups of patients were compared for two 6-month periods preceding the initial prescription (pre1 and pre2), and two 6-month periods following the initial prescription (post1 and post2). Costs were discounted to the index date.

Perspective: Payor (South Carolina Medicaid).

Patients: Those patients with schizophrenia who received initial prescriptions for risperidone (n = 862), haloperidol (n = 325) or clozapine (n = 66) between February 1994 and June 1995 (index date).

Main outcome measures and results: The mean increase in level of expenditure per person for pharmaceuticals from the pre- to the post-treatment period was significantly greater in the risperidone [751 US dollars ($US)] and clozapine ($US1423) groups than in the haloperidol group ($US6). However, the change in mean level of total mental healthcare expenditure per person was not significantly different for the risperidone group ($US832) compared with the haloperidol group ($US540) over the same time period, but the increase in the clozapine group was significantly higher ($US2500.23; p < 0.0001 for clozapinevsrisperidone and clozapine vs haloperidol).

As the difference between the risperidone and haloperidol groups in pharmaceutical expenditures was not reflected in total mental healthcare expenditures, the remaining component costs were investigated to identify where the difference was offset. Compared with haloperidol, risperidone had a significantly smaller change in per person mean level of ambulatory and inpatient physician services claims for expenditure ($US692 vs $US269, p = 0.01) and utilisation (+1.70 vs −0.21, p < 0.0001).

Conclusions: Based on these findings, we conclude that, in this population of patients with schizophrenia increased costs associated with risperidone were offset by decreases in other mental healthcare utilization. Risperidone is a technical substitute for ambulatory healthcare services.

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Author information

Authors and Affiliations

  1. The Cleveland Clinic Foundation, 9500 Euclid Ave, Desk QQb32, Cleveland, Ohio, OH 44195, USA

    Kenneth M. Shermock (Research Manager)

  2. Outcomes Research Department, Janssen Pharmaceutica, Titusville, New Jersey, USA

    M. Kay Sadik

  3. Strategic Outcomes Services of CareScience, Research Triangle Park, North Carolina, USA

    Chris M. Kozma

  4. Parke-Davis Pharmaceutical Research Outcomes Department, Ann Arbor, Michigan, USA

    Anne-Marie Sesti

  5. College of Pharmacy, University of South Carolina, Columbia, USA

    C. E. Reeder

Authors
  1. Kenneth M. Shermock
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  2. M. Kay Sadik
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  3. Chris M. Kozma
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  4. Anne-Marie Sesti
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  5. C. E. Reeder
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Shermock, K.M., Sadik, M.K., Kozma, C.M. et al. Risperidone, Haloperidol and Clozapine in the South Carolina Medicaid Program. Dis-Manage-Health-Outcomes 9, 203–213 (2001). https://doi.org/10.2165/00115677-200109040-00003

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  • DOI: https://doi.org/10.2165/00115677-200109040-00003

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