The Business Case for Expanded Clozapine Utilization

Abstract

OBJECTIVE: In most settings, less than 25% of patients with treatment-resistant schizophrenia receive clozapine, the only medication proven effective for treatment-resistant schizophrenia. Therefore, a business case analysis was conducted to assess whether increasing clozapine utilization for treatment-resistant schizophrenia in a health care system would result in direct health care cost savings. METHODS: Veterans with treatment-resistant schizophrenia who were treated in the Veterans Health Administration (VHA) were studied. Treatment response, suicides, adverse drug reactions (and associated mortality), and effects on inpatient hospitalization related to clozapine were derived from a systematic review of published studies. A one-factor sensitivity analysis and a probabilistic sensitivity analysis (PSA) with Monte Carlo simulation were conducted to calculate the cost-benefits of increased clozapine utilization. RESULTS: Despite monitoring costs, in the base case analysis, the VHA would save $22,444 per veteran with treatment-resistant schizophrenia over the first year of clozapine therapy, primarily from 18.6 fewer inpatient days per patient. If current utilization was doubled, and 50% of those veterans continued clozapine treatment for one year, VHA would save an estimated $80 million. Cost savings were most sensitive to the proportion of treatment-resistant patients who received clozapine, decrease in inpatient days, cost of inpatient stays, clozapine response rate, and number of patients with treatment-resistant schizophrenia. In the PSA, initiation of clozapine for all VHA patients with treatment-resistant schizophrenia who were not currently treated with clozapine would save at least $290 million in 95% of simulations. CONCLUSIONS: Increased clozapine utilization would result in net cost savings for the VHA

Organizational Characteristics of Veterans Affairs Clinics With High and Low Utilization of Clozapine

“…Thus increased outpatient costs may be outweighed by cost savings from reduced inpatient hospitalizations (36,37). A study described in a companion article (38) demonstrated that incremental increases in clozapine utilization could result in substantial cost savings, primarily through decreased use of inpatient admissions. Thus implementation of interventions derived from this study could more than pay for themselves, if they succeeded in increasing clozapine utilization for treatment-resistant schizophrenia.…”

Agranulocytosis secondary to clozapine: a descriptive study in chilean patients

“…Despite the known effectiveness of this drug, series have established that less than 25% of patients with schizophrenia refractory to treatment are clozapine users, 10 this scenario being their main indication given the varied clinical benefits shown in this study. 11 That is why it is important to encourage its use in the indicated cases following a strict follow-up protocol.…”

Agranulocitosis secundaria a clozapina: un estudio descriptivo en pacientes chilenos

“…A pesar de la efectividad conocida de este fár-maco, series han establecido que menos del 25% de los pacientes con Esquizofrenia refractaria a tratamiento son usuarios de clozapina 10 , siendo que este escenario es su mayor indicación dado los variados beneficios clínicos demostrados en este tipo de pacientes 11 . Es por esto que cobra relevancia el incentivar su uso en los casos indicados siguiendo un estricto protocolo de seguimiento.…”