Savings in hospital bed-days related to treatment with clozapine

The authors' aim was to determine whether clozapine was associated with a decrease in state hospital bed-days for patients with chronic schizophrenia.

Patients were started on clozapine in a state facility and were followed while taking the medication for 1.5 years (N = 172), two years (N = 86), and 2.5 years (N = 53). Patients' number of bed-days before starting clozapine was compared with those during the follow-up period.

Bed-days were reduced by an average of 132 days per year after 1.5 years, 166 days per year after two years, and 201 days per year after 2.5 years (p < .001). During the final 180 days of each follow-up period, only 23 to 30 percent of patients were continuously hospitalized, compared with 56 to 64 percent before clozapine. Forty to 57 percent of patients had no hospital days at all during the last 180 days of follow-up.

Based on hospital costs of $250 per patient per day, this reduction in bed-days could result in gross savings of about $33,000 per patient per year at 1.5 years, $41,500 per patient per year at two years, and $50,250 per patient per year at 2.5 years. Hospital patients are conspicuous targets for clozapine funding, since bed-days represent an easily measured expense. Nevertheless, community treatment should be an even higher priority, since most chronic mentally ill persons are outpatients.