Authors' objectives:

To carry out a comparative therapeutic and economic evaluation of a) clozapine in treatment-resistantschizophrenic patients or those suffering from debilitating adverse effects from conventional phenothiazines; and of b) risperidone as first line therapy for patients with schizophrenia, and in patients suffering from adverse effects from phenothiazines.

Authors' results and conclusions: 1. The cost-utility analysis demonstrated that clozapine was the dominant strategy compared to chlorpromazine or haloperidol in hospitalized patients with treatment-resistant schizophrenia with moderate symptoms. The estimated cost savings was approximately $39,000 per patient per year while producing 0.04 more quality-adjusted life years (QALYs) per year. 2. In this situation, the use of clozapine may be associated with $389 million in annual cost savings in direct health care expenditures, mainly due to reduced hospitalization. The associated incremental increase in drug expenditure would be $63 million (approximately $6,300 per patient per year). 3. The cost-utility analysis demonstrated that risperidone was the dominant strategy compared to haloperidol, haloperidol decanoate or fluphenazine decanoate in hospitalized patients with chronic schizophrenia with moderate symptoms. The estimated cost savings (versus haloperidol) was approximately $6,500 per patient per year while producing 0.04 more QALYs per year. 4. In the above situation, the use of risperidone may be associated with $662 million in annual cost savings in direct health care expenditures (overall, approximately $9,500 savings per patient per year) mainly due to reduced hospitalization. The associated incremental increase in drug expenditure would b3 $113 million (approximately $1,600 per patient per year). 5. The savings in direct health care expenditure for both of these medications were conditional upon the presence of adequate services to support the care of these patients in the community. These savings were based on a reduction in hospitalization, and no savings accrue if patients remain institutionalized due to inadequate community-based care. 6. The clinical outcome, cost, and utility results of these analyses do not apply to the more general schizophrenic population, or to those in the early stages of their disease. The role of clozapine and risperidone in these groups remains unchanged. 7. The limitations of these analyses include: the absence of long-term outcome data, thus mandating a modeling approach; the absence of a Monte Carlo sensitivity analysis to evaluate the impact of concurrent changes in multiple parameters in the model; the absence of information regarding costs or savings accrued via avoiding tardive dyskinesia; the very small number of subjects available for utility assessment; and interprovincial analyses which focused only on drug price variation and did not take into account variation in the non-drug component (primarily hospitalization and community care costs).

Project Status: Completed

URL for project: https://www.ccohta.ca/

Year Published: 1997

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Canadian Coordinating Office for Health Technology Assessment

Contact Address: 600-865 Carling Avenue, Ottawa, ON K1S 5S8 Canada. Tel: +1 613 226 2553, Fax: +1 613 226 5392;

Contact Name: requests@cadth.ca

Contact Email: requests@cadth.ca

Copyright: Canadian Coordinating Office for Health Technology Assessment.