Impact of clozapine prescription on inpatient resource utilization

Although clozapine has been demonstrated to be clinically superior to typic al neuroleptics in refractory schizophrenia, it is also more expensive. It had been hoped that the increased costs associated with its use would be of fset by decreases in the utilization of other expensive resources, especial ly inpatient care. All patients who had clozapine initiated during an inpat ient hospitalization within the VA for schizophrenia over a 4-year period ( N = 1415) were matched with a comparison group (N = 2830) on key service ut ilization variables and other possible confounding demographic and clinical variables using propensity scoring-an accepted statistical method, althoug h still relatively little used in psychiatry. By using centralized VA datab ases, subsequent inpatient resource utilization for the 3 years after index discharge was examined. Veterans exposed to clozapine while inpatients rec orded 33 (36%) more inpatient days in the subsequent 3 years after discharg e than the comparison group (124 +/- 190 days vs. 91 +/- 181 days, p = .000 2). When all patients exposed to clozapine were divided according to whethe r they had received 1 year of clozapine treatment after discharge, those th at received less than 1 year's treatment recorded significantly more inpati ent days than either those maintained on clozapine or controls. These resul ts suggest that in actual practice clozapine treatment may cost substantial ly more than treatment with conventional neuroleptics.