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Real-world clinical and cost-effectiveness of community clozapine initiation: mirror cohort study
The British Journal of Psychiatry ( IF 8.7 ) Pub Date : 2022-04-19 , DOI: 10.1192/bjp.2022.47
Emma Butler 1 , Toby Pillinger 1 , Kirsten Brown 2 , Faith Borgan 2 , Alice Bowen 2 , Katherine Beck 2 , Enrico D'Ambrosio 3 , Lisa Donaldson 4 , Sameer Jauhar 1 , Stephen Kaar 1 , Tiago Reis Marques 5 , Robert A McCutcheon 1 , Maria Rogdaki 1 , Fiona Gaughran 2 , James MacCabe 1 , Rosalind Ramsay 1 , David Taylor 1 , Paul McCrone 2 , Alice Egerton 2 , Oliver D Howes 6
Affiliation  

Background

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.

Aims

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

Method

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

Results

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).

Conclusions

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



中文翻译:

社区氯氮平启动的真实世界临床和成本效益:镜像队列研究

背景

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。

宗旨

目的是评估社区启动氯氮平的可行性和成本效益。

方法

这是对推荐接受氯氮平治疗的社区患者的自然研究。

结果

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 ) .

结论

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。

更新日期:2022-04-19
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