[Medico-economic evaluation of treatment with clozapine versus treatment with previous neuroleptics]

Abstract

Since clozapine has been introduced into the treatment of schizophrenia, pharmaceutical costs rised in hospital. However, this data is not sufficient to estimate its global effect on cost-effectiveness; that's why we studied the whole direct costs generated by schizophrenia, the clinical effectiveness as well as the impact of therapeutics on the patients' quality of life. This work is a retrospective study of cost-effectiveness of clozapine treatment within three french psychiatric hospitals. The study was divided into three parts: - a twelve-month period concerning the treatment before clozapine; - two twelve-month periods for the analysis of clozapine treatment. The clinical evaluation was based on the CGI and an autoevaluation scale. Whether schizophrenic patients were hospitalized or not and the importance of neuroleptic-associated medicines were taken into account to evaluate the Quality of Life. The economical assessment is represented by adding pharmaceutical costs, biological examinations costs and hospitalization costs. Thirty-seven patients, out of seventy-five, were being taken into account (26 men and 11 women). The results of the CGI and autoevaluation scale showed a global improvement in the pathology within the first year of treatment, which is confirmed during the second year. A statistically significant decrease in the length of full-time hospitalization was noticed; this profits to half-time hospitalization, indeed purely ambulatory. The direct costs per patient and per day insignificantly decreased between the first and the second period; on the other hand, the drop was statistically significant between the second and the third period. This study, based on a small amount of patients shows that the use of clozapine, which clearly helped the patients to improve, leads to a drop in global direct costs per patient, despite the high cost of the medicine itself, as well as an improvement in the quality of life.