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Clozapine for refractory schizophrenia: the Illinois experience
1Clinical Pharmacology Advisory Committee, The Drug Formulary, Department of Public Aid, State of Illinois, Springfield, USA. buckman@naper.com
The Journal of Clinical Psychiatry
|February 26, 1999
Summary
Clozapine effectively treated 78% of patients with treatment-resistant schizophrenia over 5 years, leading to significant cost savings through community discharges. This antipsychotic medication was well-tolerated with minimal adverse effects.
Area of Science:
- Psychiatry
- Pharmacoeconomics
- Clinical Pharmacy
Background:
- Treatment-resistant schizophrenia poses significant clinical and economic challenges.
- Clozapine is an effective but often underutilized antipsychotic for refractory cases.
Purpose of the Study:
- To evaluate the 5-year clinical effectiveness of clozapine in hospitalized patients with treatment-resistant schizophrenia.
- To assess the economic impact of clozapine treatment, including community discharge rates and cost savings.
Main Methods:
- A retrospective study utilizing a computerized clinical information system from the Illinois Department of Mental Health and Developmental Disabilities.
- Analysis of data from 518 hospitalized patients with treatment-resistant schizophrenia receiving clozapine.
- Evaluation of treatment outcomes, discontinuation rates, adverse events, and discharge data.
Main Results:
- Clozapine effectively maintained 78% of patients over 5 years.
- 243 patients were discharged to the community, contributing to approximately $20 million in annual cost savings.
- The drug was well tolerated with a low incidence of agranulocytosis.
Conclusions:
- Clozapine is a clinically effective and economically beneficial treatment for a majority of patients with treatment-resistant schizophrenia.
- A disease management algorithm for initiating clozapine could further enhance savings within the mental health system.