Mental health care as if patients mattered: A second look at CATIE

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  • 02/01/2008
Much has been made about how great and definitive large head to head studies of drugs such as CATIE or ALLHAT are in guiding what drugs to us. We at CMPI have often bee criticized when we talk about diagnostics replacing one size fits all trials as saying such personalized medicine is not ready for prime time. But what if more research – such as larger observational studies or Bayesian analysis of social experiments -- allowed a closer and statistically meaningful look at patient differences and how drugs worked? Given all available drugs and subtracting the cost of additional research how valuable – measured in terms in years free of schizophrenia -- would research that allow doctors and patients to prescribe the right drug generate.

Using the CATIE results as a baseline, Anirban Basu, PhD, David Meltzer, MD, PhD and Herb Meltzer, MD of Vanderbilt University estimate that such personalized research would be worth $342 billion over the next 20 years assuming that each additionally additional year of life free of schizophrenia is worth $50000. The authors note that this estimate does not take into account the ability to assign patients to treatment using more highly predictive algorithms that could raise the value even more. The value to more precisely establishing the cost-effectiveness of typical/atypical antipsychotics by more precisely establishing differences in patients –even in the absence of genetically based diagnostics is enormous. Considering that CATIE cost $42 million and is justified largely in terms of saving money for government, the CATIE results should not be considered definitive.

The study was sponsored by Best Practice, Inc. with partial support from the Foundation for Education and Research on Mental Illness, Janssen Pharmaceuticals, and the Center for Medicine in the Public Interest.

For full study results go to

And look under "Reports" for "Expected Value of Research on the Comparative Cost--effectiveness of Antipsychotics Drugs."

Important stuff.

Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

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