A comparative study of effectiveness, safety and cost effectiveness of olanzapine, risperidone and aripiprazole therapy in schizophrenia


  • Pooja R. Kanani Department of Pharmacology, P.D.U. Government Medical College, Rajkot, Gujarat
  • Ajita Pillai Department of Pharmacology, P.D.U. Government Medical College, Rajkot, Gujarat




Schizophrenia, Atypical antipsychotics, PANSS, Safety, Cost effectiveness


Background: Schizophrenia is the most common psychotic disorder and responsible for approximately half of long-term psychiatric hospitalizations. Antipsychotic medications reduce the psychotic symptoms and prevent relapses. The choice of drug for treatment of schizophrenia depends on many issues, including effectiveness, cost, side-effect burden, availability, and tolerability. Many studies have compared antipsychotic drugs with one another, but no broad consensus has been reached. Our study compares the clinical effectiveness, safety and cost effectiveness of atypical antipsychotics in our setting.

Methods: This was an observational, prospective study in which schizophrenia patients receiving either olanzapine, risperidone or aripiprazole were enrolled. Patients were followed up for 3 months. Evaluation of effectiveness was done by analysing mean reduction in PANSS score. Analysis of ADRs was done using WHO causality scale and Hartwig and Siegel severity scale. Cost analysis was done by comparing all three groups in term of cost range of antipsychotic drugs per improvement in PANSS score during the study period.

Results: In the present study, the average dose of antipsychotic drugs received by a patient per day was 8.83±2.98 mg in olanzapine group, 4.76±1.12 mg in risperidone group and 20.43±8.5 mg in aripiprazole group. Mean reduction in PANSS score from baseline to 12 weeks was 23.79% in olanzapine group, 25.41% in risperidone group and 24.65% in aripiprazole group. 

Conclusions: All the groups were equally effective in reduction in PANSS score while risperidone was the most cost effective.


Schizophrenia spectrum and other psychotic disorders. In: Diagnostic and Statistical manual of Mental Disorder. American Psychiatric Association. 5th ed. New Delhi: CBS; 2017: 155-188.

Whiteford HA, Degenhardt L, Rehm J. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet. 2013;382:1575-86.

National Institute for Health and Care Excellence. Clinical guideline [CG178]. Psychosis and schizophrenia in adults: prevention and management. National Institute for Health and Care excellence; 2014.

Lieberman JA, Stroup TS, Evoy MJP, Swartz MS, Rosenheck RA, Perkins DO, et al. Effectiveness of Antipsychotic Drugs in Patients with Chronic Schizophrenia. Nengl J Med. 2005;353(12):1211-23.

Kane J, Honigfeld G, Singer J, Meltzer H. Clozapine for the treatment-resistant schizophrenic: a double-blind comparison with chlorpromazine. Arch Gen Psychiatry. 1988;45:789-96.

Chavda RK, Laxmi L, Nair BS, Gandewar K. Efficacy and Tolerability of Aripiprazole in Patients with Schizophrenia and Schizoaffective Disorders. Indian J Psychiatry. 2004;46(2):150-5.

World Health Organization. World Report on Disability 2011. 2015. Available at: http://apps.who. int/iris/handle/10665/445758. Accessed on 26 November 2018.

World Health Organization. Second-generation antipsychotic medications for psychotic disorders (including schizophrenia). 2015 Available at: http://www.who.int/mental_health/mhgap/evidence/resource/psychosis_q14.pdf?ua=1. Accessed on 26 November 2018.

Ashturkar MD, Dixit JV. Selected epidemiological aspects of schizophrenia: a cross sectional study at tertiary care hospital in Maharashtra. Natl J Community. 2013;4(1):65-7.

Grath MJ, Saha S, Welham J, Saadi O, Culey CM, Chant D. A Systematic Review of the Incidence of Schizophrenia: The Distribution of Rates and Influence of Sex, Urbanicity, Migrant Status and Methodology. Biomed Central Med. 2004;13(2):1741-7015.

Frankenburg FR. Schizophrenia. 2018. Available at: https://emedicine.medscape.com/article/288259-overview#a5. Accessed on 26 November 2018.

Kothari S, Patel P, Changulani M, Agarwal A. Efficacy, tolerability and cost effectiveness of zotepine versus olanzapine in patients of acute schizophrenia Int J Basic Clin Pharmacol. 2013;2(5):577-82.

Jim VO, Allardyce J. Schizophrenia and other psychotic disorders: The Clinical Epidemiology of Schizophrenia. In: Sadock BJ, Sadock VA, Ruiz P, editors. Kaplan and Sadock’s comprehensive textbook of Psychiatry. 9th ed. New York: Wolter Kluwer| Lippincott William and willkins; 2009: 1475-1486.

Sagud M, Peles MA, Seler MD, Pivac N, Vuksan-Cusa B, Brataljenovic, et al. Smoking and schizophrenia. Psychiatr Danub. 2009;21(3):371-5.

Franz M, Ranger J, Hanewald B, Gallhofer B, Lay B. Influences on therapist’s decisions for neuroleptic treatment in schizophrenia: the role of characteristics of the patient and the physician. Pharmacopsychiatry. 2012;45(7):261-8.

Zhang JP, Gallego JA, Robinson DG, Malhotra AK, Kane JM, Correll CU. Efficacy and Safety of Individual Second-Generation vs First-Generation Antipsychotics in First Episode Psychosis: A Systematic Review and Meta-analysis. Int J Neuropsychopharmacol. 2013;16(6):1205-18.

Conley RR, Mahmoud R. A Randomized Double-Blind Study of Risperidone and Olanzapine in the Treatment of Schizophrenia or Schizoaffective Disorder. Am J Psychiatry. 2001;158:765-74.

Kumar PS, Anish PK, Rajamohan V. Olanzapine has better efficacy compared to risperidone for treatment of negative symptoms in schizophrenia. Indian J Psychiatry. 2016;58(3):311-6.

Komossa K, Kluge RC, Schwarz S, Schmid F, Hunger H, Kissling K, et al. Risperidone versus other atypical antipsychotics for Schizophrenia. Cochrane Database Syst Rev. 2014;(1):CD006626.

Jindal KC, Singh JP, Munjal V. Aripiprazole versus olanzapine in the treatment of schizophrenia: A clinical study India. Int J Psychiatry Clin Pract. 2013;17(2):21

Fitch K, Iwasaki K, Villa KF. Resource utilization and cost in a commercially insured population with schizophrenia. Am Health Drug Benefits. 2014;7(1):18-26.

Barbosa WB, Costa JO, Lemos LL, Gomes RM, Oliveira HN, Ruas CM, et al. Costs in the Treatment of Schizophrenia in Adults Receiving Atypical Antipsychotics: An 11 Years Cohort in Brazil. Appl Health Econ Health Policy. 2018;16(5):697-709.




How to Cite

Kanani, P. R., & Pillai, A. (2020). A comparative study of effectiveness, safety and cost effectiveness of olanzapine, risperidone and aripiprazole therapy in schizophrenia. International Journal of Basic & Clinical Pharmacology, 9(5), 786–791. https://doi.org/10.18203/2319-2003.ijbcp20201759



Original Research Articles