title: Cost-effectiveness of clozapine in patients with high and low levels of hospital use. Department of Veterans Affairs Cooperative Study Group on Clozapine in Refractory Schizophrenia.
abstract: BACKGROUND
  This study examined the relationship between pretreatment hospital use and the cost-effectiveness of clozapine in the treatment of refractory schizophrenia.
  
  
  METHODS
  Data from a 15-site randomized clinical trial were used to compare clozapine with haloperidol in hospitalized Veterans Affairs patients with refractory schizophrenia (n = 423). Outcomes were compared among those with many days in the hospital use (hereafter, high hospital users) (n = 141; mean = 215 psychiatric hospital days in the year prior to study entry) and those with few days in the hospital use (hereafter, low hospital users) (n = 282; mean = 58 hospital days). Analyses were conducted with the full intention-to-treat sample (n = 423) and with crossovers excluded (n = 291).
  
  
  RESULTS
  Clozapine treatment resulted in greater reduction in hospital use among high hospital users (35 days less than controls, P = .02) than among low users (21 days less than controls, P = .05). Patients taking clozapine also had lower health care costs; after including the costs of both medications and other health services, costs were $7134 less than for controls among high hospital users (P = .14) but only $759 less than for controls among low hospital users (P = .82). Clinical improvement in the domains of symptoms, quality of life, extrapyramidal symptoms, and a synthetic measure of multiple outcomes favored clozapine in both high and low hospital user groups.
  
  
  CONCLUSIONS
  Substantial 1-year cost savings with clozapine are observed only among patients with very high hospital use prior to initiation of treatment while clinical benefits are more similar across groups. Cost-effectiveness evaluations, and particularly studies of expensive treatments, cannot be generalized across type of use groups.
authors.affiliation: Veterans Affairs Connecticut Healthcare System, West Haven 06516-2770, USA. Robert.Rosenheck@Yale.EDU
authors.forename: R
authors.initials: R
authors.lastname: Rosenheck
authors.forename: J
authors.initials: J
authors.lastname: Cramer
authors.forename: E
authors.initials: E
authors.lastname: Allan
authors.forename: J
authors.initials: J
authors.lastname: Erdos
authors.forename: L K
authors.initials: LK
authors.lastname: Frisman
authors.forename: W
authors.initials: W
authors.lastname: Xu
authors.forename: J
authors.initials: J
authors.lastname: Thomas
authors.forename: W
authors.initials: W
authors.lastname: Henderson
authors.forename: D
authors.initials: D
authors.lastname: Charney
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003024:Clozapine / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D018592:Cross-Over Studies; D016527:Drug Costs; D005260:Female; D006220:Haloperidol / Q000191:economics / Q000627:therapeutic use; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012107:Research Design / Q000592:standards; D012559:Schizophrenia / Q000188:drug therapy* / Q000191:economics; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine; D006220:Haloperidol