Clozapine is the only drug licensed for treatment-resistant schizophrenia (TRS) but the real-world clinical and cost-effectiveness of community initiation of clozapine is unclear.

The aim was to assess the feasibility and cost-effectiveness of community initiation of clozapine.

This was a naturalistic study of community patients recommended for clozapine treatment.

Of 158 patients recommended for clozapine treatment, 88 (56%) patients agreed to clozapine initiation and, of these, 58 (66%) were successfully established on clozapine. The success rate for community initiation was 65.4%; which was not significantly different from that for in-patient initiation (58.82%, χ2(1,88) = 0.47, P = 0.49). Following clozapine initiation, there was a significant reduction in median out-patient visits over 1 year (from 24.00 (interquartile range (IQR) = 14.00–41.00) to 13.00 visits (IQR = 5.00–24.00), P < 0.001), and 2 years (from 47.50 visits (IQR = 24.75–71.00) to 22.00 (IQR = 11.00–42.00), P < 0.001), and a 74.71% decrease in psychiatric hospital bed days (z = −2.50, P = 0.01). Service-use costs decreased (1 year: –£963/patient (P < 0.001); 2 years: –£1598.10/patient (P < 0.001). Subanalyses for community-only initiation also showed significant cost reductions (1 year: –£827.40/patient (P < 0.001); 2 year: –£1668.50/patient (P < 0.001) relative to costs prior to starting clozapine. Relative to before initiation, symptom severity was improved in patients taking clozapine at discharge (median Positive and Negative Syndrome Scale total score: initial visit: 80 (IQR = 71.00–104.00); discharge visit 50.5 (IQR = 44.75–75.00), P < 0.001) and at 2 year follow-up (Health of Nation Outcome Scales total score median initial visit: 13.00 (IQR = 9.00–15.00); 2 year follow-up: 8.00 (IQR = 3.00–13.00), P = 0.023).

These findings indicate that community initiation of clozapine is feasible and is associated with significant reductions in costs, service use and symptom severity.

氯氮平是唯一获准用于治疗难治性精神分裂症 (TRS) 的药物，但社区开始使用氯氮平的真实临床和成本效益尚不清楚。

目的是评估社区启动氯氮平的可行性和成本效益。

这是对推荐接受氯氮平治疗的社区患者的自然研究。

在推荐接受氯氮平治疗的 158 名患者中，88 名 (56%) 患者同意开始使用氯氮平，其中 58 名 (66%) 成功地接受了氯氮平治疗。社区启动成功率为65.4%；这与住院患者开始时没有显着差异（58.82%，χ 2 (1,88) = 0.47，P = 0.49）。开始使用氯氮平后，1 年内门诊就诊次数中位数显着减少（从 24.00 次（四分位数间距 (IQR) = 14.00–41.00）减少到 13.00 次（IQR = 5.00–24.00），P < 0.001），并且2年（从 47.50 次就诊 (IQR = 24.75–71.00) 到 22.00 (IQR = 11.00–42.00)，P < 0.001），精神病住院天数减少 74.71%（z = −2.50，P= 0.01）。服务使用成本下降（1 年：–963 英镑/患者（P < 0.001）；2 年：–1598.10 英镑/患者（P < 0.001）。仅社区启动的子分析也显示成本显着降低（1 年：– 827.40 英镑/患者 ( P < 0.001)；2 年：–1668.50 英镑/患者 ( P < 0.001) 相对于开始使用氯氮平之前的费用。相对于开始使用之前，出院时服用氯氮平的患者症状严重程度有所改善（中位数阳性和阴性综合症量表总分：初次就诊：80 (IQR = 71.00–104.00)；出院就诊 50.5 (IQR = 44.75–75.00)，P< 0.001) 和 2 年随访（国家健康结果量表总分初诊中位数：13.00 (IQR = 9.00–15.00)；2 年随访：8.00 (IQR = 3.00–13.00)，P = 0.023 ) .

这些发现表明，社区开始使用氯氮平是可行的，并且与成本、服务使用和症状严重程度的显着降低有关。