Clozapine for refractory schizophrenia: the Illinois experience.
Based upon the Illinois Department of Mental Health and Developmental Disabilities' computerized clinical information system, with its integration of client-specific clinical data, a 5-year retrospective study was designed to determine the clinical effectiveness and economic impact of the use of clozapine for treatment-resistant schizophrenia. The study sample consisted of 518 hospitalized, treatment-resistant patients. At the end of 5 years, 78% were well maintained on clozapine. Two hundred forty-three patients had been discharged to the community, and 62 had been transferred for treatment of medical or surgical problems. Clozapine treatment was discontinued in 115 patients (22%). The drug was well tolerated, with a very low incidence of agranulocytosis. Cost savings resulting from the discharge of the 243 clozapine-treated patients amounts to approximately $20 million per year. A disease management algorithm has been developed allowing physicians to begin clozapine treatment for patients not successfully treated with 2 prior antipsychotic agents. Adherence to this protocol throughout the state's mental health system would result in even greater savings.
Buckman
R W
RW
Clinical Pharmacology Advisory Committee, The Drug Formulary, Department of Public Aid, State of Illinois, Springfield, USA. buckman@naper.com
Malan
R D
RD
D000328:Adult; D000465:Algorithms; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D010054:Brief Psychiatric Rating Scale / Q000706:statistics & numerical data; D002985:Clinical Protocols; D003024:Clozapine / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D016527:Drug Costs; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization; D006801:Humans; D007087:Illinois; D007256:Information Systems / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012559:Schizophrenia / Q000188:drug therapy* / Q000191:economics*; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D003024:Clozapine