Authors' objectives:

Meta-review of depot antipsychotics: To present a synthesis of the findings on the effectiveness of depot neuroleptic medications in the form of a meta-analysis, and to enable evidence-based conclusions to be drawn on the comparative efficacy of depots versus placebo, oral drugs, as well as comparative studies of one depot versus another.

Review of attitudes to depot medication To review the published literature and explore patient and nurse satisfaction with, and attitudes towards depot antipsychotic medication. Specifically, patient satisfaction with depot antipsychotic medication; the patient-preferred setting for its administration; patient preference for depot or oral antipsychotic medication; nurse (and general practitioner) satisfaction with depot antipsychotic medication.

Cost-effectiveness: To summarise evidence pertaining to the cost-effectiveness and other economic aspects of depot medication.

Authors' recommendations: Meta-review of depot antipsychotics: By combining the results from individual systematic reviews, it has been possible to summarise a great deal of clinical data on the use of depot neuroleptics. Given the number of potential comparisons and outcomes, there are very few significant results, with the exception of placebo comparisons, which demonstrate the superiority of neuroleptic treatment for schizophrenia in preventing relapse. Those significant findings that emerge from the depot versus oral comparisons suggest a marginal benefit of depots over oral drugs but on only one global outcome measure. Side-effects were in general no worse in the depot group. Relapse rates were very similar and this finding was made with good statistical power. The different depots seem to perform very similarly, with zuclopenthixol showing a slight superiority on one outcome. These conclusions must be tempered by concerns that those patients in whom an advantage from depots may be anticipated, namely those in whom adherence to medication is suboptimal, especially where non-compliance is covert, may not have been represented by the participants in these studies. Furthermore, showing clinically meaningful effects, such as a reduction in relapse rates in community dwelling people with schizophrenia over the long term, can rarely be gleaned from the published literature as it stands. Review of attitudes to depot medication: There are few data examining patient satisfaction or attitudes regarding depot antipsychotics and even less investigating the attitudes of nurses towards their role in the administration of depots. Higher quality studies are needed. What data there are show a positive attitude to depots from patients, but a broader range of patients needs to be surveyed. Cost-effectiveness: The few studies of depot neuroleptics that have made some reference to economic issues have focused very narrowly on just a few of the costs, albeit those of most interest (hospitalisation and drug costs) to healthcare decision-makers. Of greater concern is the finding that no randomised studies have been carried out to examine the cost-effectiveness of depot treatment compared to placebo, oral antipsychotics or other depot preparations, nor is the quality of the evidence from the non-randomised studies sufficient to allow conclusions to be drawn.

Authors' methods: Review, Cost study

Project Status: Completed

URL for project: http://www.hta.ac.uk/1028

Year Published: 2001

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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