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Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS 1)

Peter B. Jones, MD, PhD; Thomas R. E. Barnes, MD, DSc; Linda Davies, MSc; Graham Dunn, PhD; Helen Lloyd, BA; Karen P. Hayhurst, MSc; Robin M. Murray, MD, DSc; Alison Markwick, BA; Shôn W. Lewis, MD

Arch Gen Psychiatry. 2006;63:1079-1087.

Context  Second-generation (atypical) antipsychotics (SGAs) are more expensive than first-generation (typical) antipsychotics (FGAs) but are perceived to be more effective, with fewer adverse effects, and preferable to patients. Most evidence comes from short-term efficacy trials of symptoms.

Objective  To test the hypothesis that in people with schizophrenia requiring a change in treatment, SGAs other than clozapine are associated with improved quality of life across 1 year compared with FGAs.

Design  A noncommercially funded, pragmatic, multisite, randomized controlled trial of antipsychotic drug classes, with blind assessments at 12, 26, and 56 weeks using intention-to-treat analysis.

Setting  Fourteen community psychiatric services in the English National Health Service.

Participants  Two hundred twenty-seven people aged 18 to 65 years with DSM-IV schizophrenia and related disorders assessed for medication review because of inadequate response or adverse effects.

Interventions  Randomized prescription of either FGAs or SGAs (other than clozapine), with the choice of individual drug made by the managing psychiatrist.

Main Outcome Measures  Quality of Life Scale scores, symptoms, adverse effects, participant satisfaction, and costs of care.

Results  The primary hypothesis of significant improvement in Quality of Life Scale scores during the year after commencement of SGAs vs FGAs was excluded. Participants in the FGA arm showed a trend toward greater improvements in Quality of Life Scale and symptom scores. Participants reported no clear preference for either drug group; costs were similar.

Conclusions  In people with schizophrenia whose medication is changed for clinical reasons, there is no disadvantage across 1 year in terms of quality of life, symptoms, or associated costs of care in using FGAs rather than nonclozapine SGAs. Neither inadequate power nor patterns of drug discontinuation accounted for the result.

Author Affiliations: Department of Psychiatry, University of Cambridge and Cambridgeshire and Peterborough Mental Health NHS Trust, Cambridge (Dr Jones); Division of Neurosciences and Mental Health, Imperial College, London (Dr Barnes and Ms Lloyd); Department of Psychiatry, University of Manchester, Manchester (Mss Davies, Hayhurst, and Markwick and Drs Dunn and Lewis); and Institute of Psychiatry, London (Dr Murray), England.

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