COST-EFFECTIVENESS OF CLOZAPINE IN NEUROLEPTIC-RESISTANT SCHIZOPHRENIA

Objective: The goal of this study was to determine whether clozapine i s a cost-effective treatment for treatment-resistant schizophrenia. Me thod: Data were collected on 96 treatment-resistant patients with schi zophrenia for 2 years before they entered a clozapine treatment study and for at least 2 years after they entered the study. Information abo ut the cost of inpatient and outpatient treatment, housing costs, othe r costs, and family burden through direct interview or questionnaire o f these patients and their families were available for 47 of the 96 pa tients. Data on lost income and Social Security disability insurance w ere also obtained. Outcome measures included psychopathology, quality of life, global functioning, work function, and rehospitalization. Res ults: The cost of treatment was significantly decreased in the patient s who continued clozapine treatment for at least 2 years. This was pri marily due to a dramatic decrease in the frequency and cost of rehospi talization. Costs were nonsignificantly lower in patients who dropped out of treatment. The estimated total 2-year cost for the 59 patients who continued clozapine treatment, the 34 patients who dropped out, an d the three who interrupted treatment decreased from $7,390,206 to $S, 719,463, a savings of $8,702/year per patient. There was a decrease in total costs of $22,936/year for the 37 patients who continued clozapi ne treatment for whom cost data were available. There were no signific ant changes in lost income or Social Security disability insurance pay ments in either group. Clozapine produced a marked improvement in Brie f Psychiatric Rating Scale total scores as well as positive negative s ymptom scores, Global Assessment Scale scores, Quality of Life Scale s cores, work functioning, capacity for independent living, and rehospit alization rates. Conclusions: Clozapine is a cost-effective treatment for treatment-resistant schizophrenic patients. Cost savings result al most exclusively from the reduced cost of hospitalization.