Buckman R W, Malan R D
Clinical Pharmacology Advisory Committee, The Drug Formulary, Department of Public Aid, State of Illinois, Springfield, USA.
J Clin Psychiatry. 1999;60 Suppl 1:18-22; discussion 28-30.
Based upon the Illinois Department of Mental Health and Developmental Disabilities' computerized clinical information system, with its integration of client-specific clinical data, a 5-year retrospective study was designed to determine the clinical effectiveness and economic impact of the use of clozapine for treatment-resistant schizophrenia. The study sample consisted of 518 hospitalized, treatment-resistant patients. At the end of 5 years, 78% were well maintained on clozapine. Two hundred forty-three patients had been discharged to the community, and 62 had been transferred for treatment of medical or surgical problems. Clozapine treatment was discontinued in 115 patients (22%). The drug was well tolerated, with a very low incidence of agranulocytosis. Cost savings resulting from the discharge of the 243 clozapine-treated patients amounts to approximately $20 million per year. A disease management algorithm has been developed allowing physicians to begin clozapine treatment for patients not successfully treated with 2 prior antipsychotic agents. Adherence to this protocol throughout the state's mental health system would result in even greater savings.
基于伊利诺伊州精神健康与发育障碍部的计算机化临床信息系统及其对特定患者临床数据的整合，开展了一项为期5年的回顾性研究，以确定使用氯氮平治疗难治性精神分裂症的临床疗效和经济影响。研究样本包括518名住院的难治性患者。5年后，78%的患者通过氯氮平得到良好维持治疗。243名患者已出院回归社区，62名患者因医疗或外科问题被转院治疗。115名患者（22%）停用了氯氮平治疗。该药物耐受性良好，粒细胞缺乏症的发生率极低。243名接受氯氮平治疗的患者出院所节省的费用每年约达2000万美元。已开发出一种疾病管理算法，允许医生为之前使用两种抗精神病药物治疗未成功的患者开始氯氮平治疗。在全州精神卫生系统中遵循这一方案将带来更大的节省。
