CUtLASS: Changing attitudes and prescribing practice: cost effectiveness of first versus second generation antipsychotic drugs in people with schizophrenia

Impact: Health impacts, Economic impacts


Schizophrenia affects 1% of people, usually leading to lifelong disability. Antipsychotic drugs, first developed in the 1950s, are the mainstay of treatment. A new class of second generation antipsychotic (SGA) drugs was introduced in the 1990s. SGA drugs cost 20-30 times more than first generation (FGA) drugs. Research at the University of Manchester (UoM) between 1999 and 2003 demonstrated that, against globally-held expectations, the heavily-promoted SGA drugs (global market value 2008 $18.2bn – Datamonitor) had no advantages in effectiveness, tolerability, or patient preference over more cost-effective FGA drugs. The results have informed clinical guidelines in the UK (NICE), USA, Canada and other countries, with evidence of change in prescribing practice.

Category of impact

  • Health impacts
  • Economic impacts

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