Meltzer H Y, Cola P A
Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio.
J Clin Psychiatry. 1994 Sep;55 Suppl B:161-5.
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.
The three studies of the primary data relevant to a pharmacoeconomic analysis of clozapine in the treatment of schizophrenia were reviewed.
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.
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.
氯氮平的药物经济学分析尤为重要，因为与典型抗精神病药物相比，氯氮平在获益、风险和成本方面具有独特的特征，并且尽管已发现其在多种其他适应症（例如难治性双相情感障碍患者）中也有用，但目前仅被批准用于两类人群，即对抗精神病药物耐药和不耐受的精神分裂症患者。
回顾了三项与氯氮平治疗精神分裂症的药物经济学分析相关的主要数据研究。
结果表明，与典型抗精神病药物相比，氯氮平用于治疗对抗精神病药物耐药的精神分裂症时，由于住院次数减少，即使将与氯氮平治疗中断相关的成本计算在内，对于难治性患者也能带来更好的治疗效果和更低的治疗成本。目前尚无氯氮平其他适应症的药物经济学数据。
已发现氯氮平与典型抗精神病药物的既往治疗相比，在对抗精神病药物耐药的患者中能产生更优的治疗效果，这些效果可轻易转化为成本效益指标，如精神病理学症状减轻、认知改善、再次住院率降低、自杀企图减少以及工作功能改善。如果患者的住院频率较高，且氯氮平治疗中断率在30%至50%之间，并且在开始治疗后的1至4个月内发生，那么氯氮平很可能是一种具有成本效益的治疗方法。对于氯氮平的每种应用，包括用于对抗精神病药物不耐受的患者，都需要进行将氯氮平与标准治疗进行比较的成本效益研究。
