Risperidone: Clinical outcome predictors and cost-effectiveness in a naturalistic setting

Although risperidone seems to be a safe and effective treatment for the man agement of psychotic symptoms, its acquisition cost is considerably higher than that of conventional antipsychotics, and its precise role in managing psychiatric illnesses has yet to be defined. The purpose of this investigat ion was to examine the relationship of patient demographic variables to the rapeutic outcomes and to analyze the financial impact of risperidone on the treatment of psychotic symptoms, Subjects included in this 2-year, retrospective cohort, intent-to-treat ana lysis were all patients initiated on risperidone therapy at an inpatient ps ychiatric treatment facility. Clinical outcomes were assessed from the abso lute change in hospitalized days, total number of psychotropic medications prescribed, and historic Clinical Global Impression severity scores, Logist ic regression analysis was conducted to analyze the potential relationship to certain demo-graphic variables to therapeutic response, The cost-benefit analysis compared the direct treatment costs incurred by the institution b efore and after risperidone initiation. Of the 66 patients originally started on risperidone, 57 completed a therap eutic trial, A clinical response was evident in 54 percent of these patient s overall, Logistic regression analysis identified previous treatment intol erance and a negative history of substance abuse as predictive of therapeut ic success with risperidone (p=.0006 and p=.01, respectively). Hospitalizat ion rates declined by 43 percent among treatment responders and by 1.3 perc ent among nonresponders resulting in a net annual savings of $147,962. Risperidone may be efficacious in many patients who had previously failed a ntipsychotic trials. Patients who had been unable to tolerate traditional a ntipsychotics and those who lacked a documented history of substance abuse were uniquely responsive to risperidone treatment. The significant decline in hospitalized days that was observed among responsive patients seems to i ndicate that risperidone may be a cost-effective approach to the management of psychotic symptoms.