When Eli Lilly Spins

Here's a study from Eli Lilly that's a well-timed attempt to gently counteract the landmark CATIE study released in September. The take away from CATIE is that atypical antipsychotics don't perform much better than first-generation antipsychotics yet cost 10 times more. The implication for treatment for schizophrenics was the fear among mental health adovcates and clinicians that state mental health systems--each state has its own Medicaid system, and pays for care of millions of schizophrenics nationwide to the tune of $4 billion to $5 billion in medication costs--would try to force many patients back onto the older, cheaper antipsychotics in order to save money. In Washington State, for one, the state Medicaid system spends $100 million a year on antipsychotics--about two-thirds of that goes for schizophrenia treatment, the rest for bipolar disorder--and $90 million of that goes for atypicals. State like California and Flordia spend many times more on atypicals.

Such a move away from atypicals would be billions of dollars of bad news for pharma companies. Eli Lilly, in particular, has aggressively responded to these implications by releasing positive news about Zyprexa, an atypical antipsychotic that's worth about $3 billion in annual sales.

This time out, the company claims that results of a study of schizophrenics taking Zyprexa show that atypicals are justified by lower cost, once total treatment costs for patients are taken into account. Total costs include medications, hospitalizations and doctor visits. It's not clear to me whether the total figure includes annual housing costs and disability payments.

That said, the data show that the average patient taking Zyprexa in the study group costs $20,891, $21,347 for Risperdal (a competing atypical) and $21,283 for patients taking first-generation antipsychotics. That's not even a significant difference, so why Lilly is touting this as news that atypicals cost less overall compared to older meds is beyond me. You just have to read the study results to figure that out.

My take on that same data, however, is to partly agree with Lilly, but not for the reason the company claims. As harsh as it sounds, atypicals like Zyprexa are the best deal that schizophrenics have got. They don't zombiefy patients the way older antipsychotics do. That alone justifies use of atypicals in schizophrenics.

What is striking news from the study is just how much money an average schizophrenic costs the public each year--about $21,000. (If housing and disability payments need to be added atop that figure, the cost would be around $30,000 a year.) That's a lot of money, well worth it when you consider that housing such patients at a state mental hospital can easily top $100,000 per patient. But it's still a ton of money per patient. Patients who aren't in the public system--meaning they are on private insurance or nothing at all--likely cost far less.

By comparison, a large HMO in Washington State tells me that the average bipolar in its system costs about $3,200 a year in total costs.

What the study doesn't address at all are the side effects of these meds on patients' bodies. But that's another story.