 |
|
Cost-effectiveness of Clozapine Compared With Conventional Antipsychotic Medication for Patients in State Hospitals
Susan M. Essock, PhD;
Linda K. Frisman, PhD;
Nancy H. Covell, PhD;
William A. Hargreaves, PhD
Arch Gen Psychiatry. 2000;57:987-994.
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.
From the Department of Psychiatry, Mount Sinai School of Medicine, and Veterans Affairs New York Healthcare System, Mental Illness Research, Education, and Clinical Center, New York, NY (Dr Essock); Connecticut Department of Mental Health and Addiction Services, Hartford, and the Department of Psychology, University of Connecticut, Storrs (Drs Essock, Frisman, and Covell); and Department of Psychiatry, University of California, San Francisco (Dr Hargreaves).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Cost-effectiveness of Competing Strategies for the Treatment of Pediatric Empyema
Cohen et al.
Pediatrics 2008;121:e1250-e1257.
ABSTRACT
| FULL TEXT
Clinical Trial-Based Cost-Effectiveness Analyses of Antipsychotic Use
Polsky et al.
Am. J. Psychiatry 2006;163:2047-2056.
ABSTRACT
| FULL TEXT
Cost-Effectiveness of Second-Generation Antipsychotics and Perphenazine in a Randomized Trial of Treatment for Chronic Schizophrenia
Rosenheck et al.
Am. J. Psychiatry 2006;163:2080-2089.
ABSTRACT
| FULL TEXT
Atypical antipsychotic agents in the treatment of violent patients with schizophrenia and schizoaffective disorder.
Krakowski et al.
Arch Gen Psychiatry 2006;63:622-629.
ABSTRACT
| FULL TEXT
Open Forum: Effectiveness Versus Efficacy of Second-Generation Antipsychotics: Haloperidol Without Anticholinergics as a Comparator
Rosenheck
Psychiatr. Serv. 2005;56:85-92.
FULL TEXT
Effectiveness and Cost of Olanzapine and Haloperidol in the Treatment of Schizophrenia: A Randomized Controlled Trial
Rosenheck et al.
JAMA 2003;290:2693-2702.
ABSTRACT
| FULL TEXT
Clozapine v. conventional antipsychotic drugs for treatment-resistant schizophrenia: a re-examination
MONCRIEFF
Br. J. Psychiatry 2003;183:161-166.
ABSTRACT
| FULL TEXT
Switching Therapy in Health Economics Trials: Confronting the Confusion
Torrance et al.
Med Decis Making 2003;23:335-340.
ABSTRACT
An Economic Review of Compliance With Medication Therapy in the Treatment of Schizophrenia
Thieda et al.
Psychiatr. Serv. 2003;54:508-516.
ABSTRACT
| FULL TEXT
Outpatient Prescriptions for Atypical Antipsychotics for African Americans, Hispanics, and Whites in the United States
Daumit et al.
Arch Gen Psychiatry 2003;60:121-128.
ABSTRACT
| FULL TEXT
Cost and Cost-effectiveness of Hospital vs Residential Crisis Care for Patients Who Have Serious Mental Illness
Fenton et al.
Arch Gen Psychiatry 2002;59:357-364.
ABSTRACT
| FULL TEXT
The cost-effectiveness of clozapine: a controlled, population-based, mirror-image study
Hayhurst et al.
J Psychopharmacol 2002;16:169-175.
ABSTRACT
Recent advances: Psychiatry
Lyons and McLoughlin
BMJ 2001;323:1228-1231.
FULL TEXT
Other articles noted
Evid. Based Ment. Health 2001;4:36-36.
FULL TEXT
|
