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document
Cost-effectiveness of clozapine compared with conventional antipsychotic medication for patients in state hospitals . BACKGROUND An open-label , randomized controlled trial compared clozapine with physicians'-choice medications among long-term state hospital inpatients in Connecticut . The goal was to examine clozapine 's cost-effectiveness in routine practice for people experiencing lengthy hospitalizations . METHODS Long-stay patients with schizophrenia in a state hospital were randomly assigned to begin open-label clozapine ( n = 138 ) or to continue receiving conventional antipsychotic medications ( n = 89 ) . We interviewed study participants every 4 months for 2 years to assess psychiatric symptoms and functional status , and we collected continuous measures of prescribed medications , service utilization , and other costs . We used both parametric and nonparametric techniques to examine changes in cost and parametric analyses to examine changes in effectiveness . We used bootstrap techniques to estimate incremental cost-effectiveness ratios and create cost-effectiveness acceptability curves . RESULTS Both groups incurred similar costs during the 2-year study period , with a trend for clozapine to be less costly than usual care in the second study year . Clozapine was more effective than usual care on many but not all measures . With the use of effectiveness measures that favored clozapine ( extrapyramidal side effects , disruptiveness ) , bootstrap techniques indicated that , even when a payer is unwilling to incur any additional cost for gains in effectiveness , the probability that clozapine is more cost-effective than usual care is at least 0.80 . These findings were not as evident when outcomes where clozapine was not clearly superior ( psychotic symptoms , weight gain ) were examined . CONCLUSION Clozapine demonstrated cost-effectiveness on some but not all measures of effectiveness when the alternative was a range of conventional antipsychotic medications .
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Intervention_Pharmacological
clozapine
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Intervention_Pharmacological
clozapine
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Intervention_Control
continue receiving conventional antipsychotic medications
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Intervention_Pharmacological
Clozapine
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Intervention_Pharmacological
clozapine
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Intervention_Pharmacological
Clozapine
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Outcome_Other
cost-effectiveness
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Outcome_Mental
assess psychiatric symptoms
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Outcome_Physical
functional status
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Outcome_Other
changes in cost
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Outcome_Physical
parametric analyses
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Outcome_Other
changes in effectiveness
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Outcome_Other
estimate incremental cost-effectiveness ratios
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Outcome_Other
cost-effectiveness acceptability curves
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Outcome_Other
effective
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Outcome_Other
effectiveness measures
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Outcome_Other
more cost-effective
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Outcome_Mental
psychotic symptoms
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Outcome_Physical
weight gain
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Outcome_Other
cost-effectiveness
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Participant_Condition
patients in state hospitals
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Participant_Condition
long-term state hospital inpatients
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Participant_Condition
people experiencing lengthy hospitalizations
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Participant_Sample-size
138
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Participant_Sample-size
89