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PSYCHIATRY

Schizophrenia: Multi-Attribute Utility Theory Approach to Selection of Atypical Antipsychotics

Assistant Professor, Divisions of Pharmacy Practice and Administration, College of Pharmacy, The University of Texas at Austin, Austin, TX

Garyn Shuler, PharmD LT MSC USN

at time of writing, PharmD Student, College of Pharmacy, The University of Texas at Austin; now, Inpatient Pharmacy Division Officer, Naval Hospital Bremerton, Bremerton, WA

Donnamaria R Jones, PharmD Lt Col BSC

Commander, Pharmacy Flight, Malcolm Grow Medical Center, Andrews AFB, MD

James P Wilson, PhD

Associate Professor, Divisions of Pharmacy Practice and Administration, College of Pharmacy, The University of Texas at Austin

Reprints: Dr. Bettinger, Division of Pharmacy Practice, College of Pharmacy, The University of Texas at Austin, 1 University Station, MC A1910, Austin, TX 78712, fax 512/471-3756, bettinger{at}mail.utexas.edu

BACKGROUND: Current guidelines/algorithms recommend atypical antipsychotics as first-line agents for the treatment of schizophrenia. Because there are extensive healthcare costs associated with the treatment of schizophrenia, many institutions and health systems are faced with making restrictive formulary decisions regarding the use of atypical antipsychotics. Often, medication acquisition costs are the driving force behind formulary decisions, while other treatment factors are not considered.

OBJECTIVE: To apply a multi-attribute utility theory (MAUT) analysis to aid in the selection of a preferred agent among the atypical antipsychotics for the treatment of schizophrenia.

METHODS: Five atypical antipsychotics (risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole) were selected as the alternative agents to be included in the MAUT analysis. The attributes identified for inclusion in the analysis were efficacy, adverse effects, cost, and adherence, with relative weights of 35%, 35%, 20%, and 10%, respectively. For each agent, attribute scores were calculated, weighted, and then summed to generate a total utility score. The agent with the highest total utility score was considered the preferred agent.

RESULTS: Aripiprazole, with a total utility score of 75.8, was the alternative agent with the highest total utility score in this model. This was followed by ziprasidone, risperidone, and quetiapine, with total utility scores of 71.8, 69.0, and 65.9, respectively. Olanzapine received the lowest total utility score. A sensitivity analysis was performed and failed to displace aripiprazole as the agent with the highest total utility score.

CONCLUSIONS: This model suggests that aripiprazole should be considered a preferred agent for the treatment of schizophrenia unless found to be otherwise inappropriate.

Key Words: atypical antipsychotics, multi-attribute utility theory, schizophrenia

Published Online, February 13, 2007. www.theannals.com, DOI 10.1345/aph.1G607

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