INITIATING CLOZAPINE TREATMENT IN THE OUTPATIENT-CLINIC - SERVICE UTILIZATION AND COST TRENDS

Objective: Clozapine has been shown to be a cost-effective treatment f or refractory psychosis among patients started on the medication in a hospital setting. The study examined service utilization and costs ass ociated with clozapine treatment initiated in an outpatient clinic. Me thods: Subjects (N=28) included adult patients with a diagnosis of sch izophrenia or schizoaffective disorder who began their clozapine treat ment at an urban community mental health center. Subjects' charts were reviewed for information on service utilization in the year before an d after starting clozapine, using an intent-to-treat approach. Hospita lization information was cross-checked against the Illinois Department of Human Services database. Costs were computed for hospitalization, medication, community outpatient services, and housing. Results: Subje cts' mean rate of hospitalization was reduced by more than half during the clozapine treatment year, and the mean number of days in the hosp ital decreased by more than two-thirds, from 23.5 days to 7.6 days. Me an hospitalization costs were reduced by more than half. Mean annual c osts of medication rose from $648 in the year before clozapine treatme nt to $6,760 during the clozapine treatment year. Cost increases for m edication, community services, and housing led to a marginal increase in the total cost of treatment. Conclusions: Patients initiating cloza pine treatment on an outpatient basis showed a pattern of decreased, h ospitalization during the first year on clozapine. The cost savings as sociated with decreased hospitalization substantially, though not full y, offset the increased expense of clozapine during the first year of community-based treatment.