The pharmacoeconomics of clozapine: A review

Background: A pharmacoeconomic analysis of clozapine is of particular importance because clozapine has a unique profile of benefits, risks, and costs relative to typical neuroleptic drugs and because it is currently approved for use in only two populations, i.e., neuroleptic-resistant and neuroleptic-intolerant schizophrenic patients, although it has also been found to be useful in a variety of other indications, e.g., refractory bipolar patients. Method: The three studies of the primary data relevant to a pharmacoeconomic analysis of clozapine in the treatment of schizophrenia were reviewed. Results: The results suggest that clozapine as a treatment of neuroleptic-resistant schizophrenia leads to better outcome and lower costs in treatment-resistant patients compared with typical neuroleptic drugs because of decreased hospitalization, even when the costs associated with dropouts from clozapine are included. No pharmacoeconomic data are available for other indications of clozapine. Conclusion: Clozapine has been found to produce superior outcome compared with prior treatment with typical neuroleptic drugs in neuroleptic-resistant patients in dimensions that can be readily transformed into cost-utility measures such as decreased psychopathology, improved cognition, decreased rehospitalization, decreased suicide attempts, and better work function. If the frequency of hospitalization of patients has been appreciable, and dropouts from clozapine are in the range of 30% to 50% and occur within 1 to 4 months of starting treatment, it is likely that clozapine will be a cost-effective treatment. Cost-effectiveness studies comparing clozapine with standard treatments are needed for each application of clozapine, including use in neuroleptic- intolerant patients.