title: Cost-benefit analysis of risperidone and clozapine in the treatment of schizophrenia in Israel.
abstract: In this study, the benefits and costs of treating schizophrenia with either risperidone or clozapine were examined. The lifetime drug-treatment cost incurred by a patient with schizophrenia in Israel was $US7561 (1996 values) with an initial 6-month trial with risperidone, compared with $US6326 with clozapine and $US3360 with typical antipsychotics. Total lifetime costs of psychiatric health services (excluding medications) by individuals who were continuously receiving typical antipsychotics were $US181,555 per patient. Assuming a 6.3% decrease in hospital use with typical antipsychotics and an absolute 30% decrease with risperidone or clozapine, the use of clozapine or risperidone reduced hospitalisation costs by $US7159 per patient, but increased community-care costs by $US1627 per patient, giving health-service benefit:cost ratios of 1.87:1 and 1.32:1, respectively. After adding indirect benefits resulting from increased work productivity (minus indirect costs related to increases in transport costs because of visits for blood monitoring during clozapine therapy), the benefit:cost ratios increased to 2.04:1 and 1.48:1, respectively. Assuming that clozapine caused a 30% decrease in hospital use by patients with new-onset schizophrenia, risperidone would have to decrease hospital use by 43.2% (i.e. a 13.2% relative advantage) for its societal benefits to justify its increased costs.
authors.affiliation: Department of Medical Technology Assessment, Ministry of Health, Jerusalem, Israel. mttgary@matat.health.gov.il
authors.forename: G
authors.initials: G
authors.lastname: Ginsberg
authors.forename: S
authors.initials: S
authors.lastname: Shani
authors.forename: B
authors.initials: B
authors.lastname: Lev
mesh_terms: D014150:Antipsychotic Agents / Q000191:economics* / Q000627:therapeutic use; D003024:Clozapine / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D006801:Humans; D007557:Israel; D018967:Risperidone / Q000191:economics* / Q000627:therapeutic use; D012559:Schizophrenia / Q000188:drug therapy / Q000191:economics*