Several individual searches of the databases MEDLINE and HEALTHSTAR were conducted in August 1999. All searches were limited to human subjects and English language. Cost studies were restricted to studies conducted in the United States, unless no studies for that agent were available. In this case, selected studies conducted in Europe or Canada were included. Relevant articles identified through the literature search were obtained and reviewed. Subsequent to this review, we collected additional literature cited in the reference section of the review articles. The formal literature review was supplemented by studies maintained in-house by our expert mental health services staff. Because the first of the pharmaceuticals of interest to this study was introduced in 1988 (fluoxetine, i.e., Prozac®), the literature searches were restricted to articles published from 1988.
These literature searches had several goals:
- Identify articles that describe the prevalence and impact of major depression and schizophrenia in the US
- Identify published articles that describe the impact of barriers on access to and utilization of new pharmaceutical agents
- Identify articles that compare the effectiveness of newer pharmacotherapies to older ones and seek to establish appropriate treatment criteria. The survey focused primarily on real-world effectiveness studies, in order to capture the extent to which the newer medications are associated with improved treatment compliance and the potential to offset costs related to subsequent delay or prevention of psychiatric relapse, recurrence of illness, or re-hospitalization.
- Identify articles that evaluate the cost-effectiveness of newer antidepressant and antipsychotic medications. This literature search encompassed cost-effectiveness across all areas of service delivery with particular emphasis on the often-competing interests of various cost centers.
In addition, The Lewin Group obtained and reviewed both formulary policies and clinical practice guidelines of selected health plans, insurance programs, public health care delivery systems, and managed care organizations. Strict guidelines were followed to preserve anonymity and confidentiality in order to protect the proprietary interests of the organizations involved.