Cost-effectiveness clozapine

Ghaemi SN, Ziegler DM, Peachey TJ, et al (1998). Cost-effectiveness of clozapine therapy for severe psychosis. Psychiatr Serv A y 829—31. 

Jonsson D, WSlinder J (1995). Cost-effectiveness of clozapine treatment in therapy-refractory schizophrenia. Aaa Psychiatr Scand l 199-201. 

Revicki DA, Luce BR, Weschler JM et al (1990). Cost-effectiveness of clozapine for treatment-resistant schizophrenic patients. Hosp Community Psychiatry 850-69. 

Knapp (1998) has noted that there is a need to know if additional treatment costs have a downstream pay-off in system-wide cost-effectiveness. This is almost certainly the case for clozapine, but it is less clear for other drugs. Knapp (1998) argues that cost-effectiveness studies need to be part of the initial evaluative process rather than an afterthought. In this respect very new drugs may have an advantage as these calculations can be built into the current registration... 

Meltzer HY, Cola PH, Way L, et al. Cost effectiveness of clozapine in neuroleptic-resistant schizophrenia. Am J Psychiatry 1993 150 1630-1638. 

Because the expense of health care in the United States has increased dramatically in recent years, it appears reasonable to consider the cost effectiveness of these tests [93]. A pilot study of the cost effectiveness of CYP2D6 testing [94] and a model for pharmacogenetic testing for clozapine have been published [95]. However, one needs to acknowledge that many medical advances are not cost effective. In psychiatry, the switch from typical to atypical antipsychotics has been associated with a remarkable increase in drug costs (probably by a factor of six) without reduced expenses in other types of medical care [96]. 

Zhang M, Owen RR, Pope SK, Smith GR. Cost-effectiveness of clozapine monitoring after the first 6 months. Arch Gen Psychiatry... 

Hayhurst KP, Brown P, Lewis SW. The cost-effectiveness of clozapine A controlled, population-based mirror-image study. J Psychopharmacol... 

Controlled mirror-image studies of clozapine (Table 2.2) show primarily that all interventions evaluated seem to reduce healthcare costs by reducing hospitalization, but that the effect of clozapine is greater. These results are more compelling than those from the uncontrolled studies, not only because of the inclusion of a contemporary control, but also because these studies tended to be larger and longer. 

Fortunately, for most psychotropics, side effects are minimal, usually involving nuisance complaints. With some agents, such as clozapine, however, the potential for more serious adverse effects does exist and must be carefully explained to the patient and family. Although managed care has successfully controlled overall financial costs, it is our responsibility to advocate for the optimal delivery of treatment, which necessarily takes into consideration not only the immediate expense of treatment but the impact of appropriate care in the long-term. As importantly, one should always factor in the cost of not providing adequate treatment, including ... 

The cost to the patient - 9000 annually. The effectiveness of clozapine in the treatment of schizophrenia was considered very good especially in light of the fact that the extrapyramidal side effects, compared to other... 

Clozapine has a very low incidence of extrapyramidal side effects and very few cases of tardive dyskinesia. It is very sedating and has some anticholinergic and an-tiadrenergic side effects (see Fig. 17-B). Sedation is the most troublesome side effect. Clozapine lowers the seizure threshold and can cause hepatitis. The most serious side effect, however, is a severe blood disorder, aplastic anemia, which has caused several deaths in the United States. These deaths have occurred despite the mandatory weekly monitoring of white blood cell count. Clozapine can cost as much as 10,000 per year because of the need for weekly blood tests, although this cost is offset by reduced hospitalizations. Also, there have been a few sudden deaths associated with clozapine, presumably cardiac in nature. 

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