Context

Treatment alternatives

The NICE clinical guideline on psychosis and schizophrenia recommends that people with a first episode of schizophrenia, or an acute exacerbation or recurrence of schizophrenia, should be offered oral antipsychotic medication in conjunction with psychological interventions. The NICE clinical guideline also recommends that depot or long-acting antipsychotics may be offered to people who would prefer such treatment after an acute episode of schizophrenia, or where avoiding covert non-adherence (either intentional or unintentional) to antipsychotic medication is a clinical priority within the treatment plan.

The NICE clinical guideline recommends that the choice of antipsychotic medication should be made by the service user and healthcare professional together, taking into account the views of the carer if the service user agrees. Information should be provided on, and there should be discussion about, the likely benefits and possible side effects of each drug, including metabolic, extrapyramidal, cardiovascular, hormonal and other side effects (including unpleasant subjective experiences). The BNF chapter on antipsychotic drugs describes the relative efficacy and adverse effects of different antipsychotics. A National Prescribing Centre patient decision aid provides a guide to the relative adverse effects of different antipsychotics, based on information available at that time (2009).

Costs of selected treatment alternatives

All drugs in the table below are prolonged-release intramuscular injections. The table includes both first (haloperidol, fluphenazine, flupentixol, pipotiazine, and zuclopenthixol) and second (aripiprazole, risperidone, olanzapine, and paliperidone) generation antipsychotics.

Dose regimen a

Cost per year excluding VAT b

Aripiprazole

400 mg once monthly

£2,645

Risperidone

25–50 mg every 2 weeks

£2,072 to £3,712

Olanzapine pamoate

150–300 mg every 2 weeks or 300–405 mg every 4 weeks

£2,894 to £5,789

Paliperidone palmitate

25–150 mg once monthly

£2,207 to £4,711

Haloperidol decanoate

50–300 mg every 4 weeks

£50 to £197

Fluphenazine decanoate

12.5–100 mg every 2 to 5 weeks

£13 to £227

Flupentixol decanoate

50 mg every 4 weeks to 300 mg every 2 weeks

£49 to £156

Pipotiazine palmitate

50–100 mg every 4 weeks

£212 to £347

Zuclopenthixol decanoate

200–500 mg every 1 to 4 weeks

£26 to £189

a Doses taken from the relevant summary of product characteristics. The doses shown may not represent the full range that can be used and they do not imply therapeutic equivalence.

b Costs taken from MIMS, February 2014.