Is clozapine cost-effective? Unanswered issues

The treatment of schizophrenia accounts for approximately 2.5% of national healthcare expenditures, with the majority of this expense concentrated on costly in-patient services. Health policy leaders have expressed concern that these costs create a strain on limited resources. Newer antipsychotic pharmacotherapies, such as clozapine (Clozaril, Leponex; Novartis), may improve patient symptoms and potentially lower hospital use. However, the high cost of these pharmaceutical treatments must be considered alongside any savings in hospital costs and improvement in patient functioning, when assessing the overall economic impact of using such treatment on schizophrenic patients. This review examines six key cost-effectiveness studies that address the economic considerations and quality-of-life issues associated with the use of clozapine in battling the burdens of schizophrenia to determine whether in fact the use of clozapine is clinically and economically appropriate. As such, the review suggests: (a) treatment with clozapine significantly improves patient symptoms and quality of life; (b) patients who receive clozapine experience a reduction in the number of hospitalizations, which can lead to a decrease in hospital costs; (c) treating patients with clozapine shifts the cost structure from impatient care to outpatient care and drug therapies; and (d) patients who receive clozapine can experience a reduction in overall treatment costs. However, several cost considerations remain unaccounted in most studies, and a serious effort is needed to conduct studies of the vast numbers of outpatients who might benefit from treatment with clozapine.