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Am J Psychiatry 1993; 150:1630-1638
Copyright © 1993 by American Psychiatric Association
Cost effectiveness of clozapine in neuroleptic-resistant schizophrenia
HY Meltzer, P Cola, L Way, PA Thompson, B Bastani, MA Davies and B Snitz
Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, OH.
OBJECTIVE: The goal of this study was to determine whether clozapine is a
cost-effective treatment for treatment-resistant schizophrenia. METHOD:
Data were collected on 96 treatment-resistant patients with schizophrenia
for 2 years before they entered a clozapine treatment study and for at
least 2 years after they entered the study. Information about the cost of
inpatient and outpatient treatment, housing costs, other costs, and family
burden through direct interview or questionnaire of these patients and
their families were available for 47 of the 96 patients. Data on lost
income and Social Security disability insurance were also obtained. Outcome
measures included psychopathology, quality of life, global functioning,
work function, and rehospitalization. RESULTS: The cost of treatment was
significantly decreased in the patients who continued clozapine treatment
for at least 2 years. This was primarily due to a dramatic decrease in the
frequency and cost of rehospitalization. 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, and the three who interrupted treatment decreased from
$7,390,206 to $5,719,463, 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
clozapine treatment for whom cost data were available. There were no
significant changes in lost income or Social Security disability insurance
payments in either group. Clozapine produced a marked improvement in Brief
Psychiatric Rating Scale total scores as well as positive negative symptom
scores, Global Assessment Scale scores, Quality of Life Scale scores, work
functioning, capacity for independent living, and rehospitalization rates.
CONCLUSIONS: Clozapine is a cost-effective treatment for
treatment-resistant schizophrenic patients. Cost savings result almost
exclusively from the reduced cost of hospitalization.
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