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Real-world clinical and cost-effectiveness of community clozapine initiation: mirror cohort study.

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Title: Real-world clinical and cost-effectiveness of community clozapine initiation: mirror cohort study.
Authors: Butler, Emma (AUTHOR), Pillinger, Toby (AUTHOR), Brown, Kirsten (AUTHOR), Borgan, Faith (AUTHOR), Bowen, Alice (AUTHOR), Beck, Katherine (AUTHOR), D'Ambrosio, Enrico (AUTHOR), Donaldson, Lisa (AUTHOR), Jauhar, Sameer (AUTHOR), Kaar, Stephen (AUTHOR), Marques, Tiago Reis (AUTHOR), McCutcheon, Robert A. (AUTHOR), Rogdaki, Maria (AUTHOR), Gaughran, Fiona (AUTHOR), MacCabe, James (AUTHOR), Ramsay, Rosalind (AUTHOR), Taylor, David (AUTHOR), McCrone, Paul (AUTHOR), Egerton, Alice (AUTHOR), Howes, Oliver D. (AUTHOR)
Source: British Journal of Psychiatry. Dec2022, Vol. 221 Issue 6, p740-747. 8p.
Subjects: Communities, Clozapine, Cost effectiveness, Cohort analysis, Cost control
Abstract: 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. [ABSTRACT FROM AUTHOR]
Copyright of British Journal of Psychiatry is the property of Cambridge University Press and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Real-world clinical and cost-effectiveness of community clozapine initiation: mirror cohort study.
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  Data: &lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Butler%2C+Emma%22&quot;&gt;Butler, Emma&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Pillinger%2C+Toby%22&quot;&gt;Pillinger, Toby&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Brown%2C+Kirsten%22&quot;&gt;Brown, Kirsten&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Borgan%2C+Faith%22&quot;&gt;Borgan, Faith&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Bowen%2C+Alice%22&quot;&gt;Bowen, Alice&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Beck%2C+Katherine%22&quot;&gt;Beck, Katherine&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22D&#39;Ambrosio%2C+Enrico%22&quot;&gt;D&#39;Ambrosio, Enrico&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Donaldson%2C+Lisa%22&quot;&gt;Donaldson, Lisa&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Jauhar%2C+Sameer%22&quot;&gt;Jauhar, Sameer&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Kaar%2C+Stephen%22&quot;&gt;Kaar, Stephen&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Marques%2C+Tiago+Reis%22&quot;&gt;Marques, Tiago Reis&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22McCutcheon%2C+Robert+A%2E%22&quot;&gt;McCutcheon, Robert A.&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Rogdaki%2C+Maria%22&quot;&gt;Rogdaki, Maria&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Gaughran%2C+Fiona%22&quot;&gt;Gaughran, Fiona&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22MacCabe%2C+James%22&quot;&gt;MacCabe, James&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Ramsay%2C+Rosalind%22&quot;&gt;Ramsay, Rosalind&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Taylor%2C+David%22&quot;&gt;Taylor, David&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22McCrone%2C+Paul%22&quot;&gt;McCrone, Paul&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Egerton%2C+Alice%22&quot;&gt;Egerton, Alice&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Howes%2C+Oliver+D%2E%22&quot;&gt;Howes, Oliver D.&lt;/searchLink&gt; (AUTHOR)
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  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%22British+Journal+of+Psychiatry%22&quot;&gt;British Journal of Psychiatry&lt;/searchLink&gt;. Dec2022, Vol. 221 Issue 6, p740-747. 8p.
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  Data: &lt;bold&gt;Background: &lt;/bold&gt;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.&lt;bold&gt;Aims: &lt;/bold&gt;The aim was to assess the feasibility and cost-effectiveness of community initiation of clozapine.&lt;bold&gt;Method: &lt;/bold&gt;This was a naturalistic study of community patients recommended for clozapine treatment.&lt;bold&gt;Results: &lt;/bold&gt;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 &lt; 0.001), and 2 years (from 47.50 visits (IQR = 24.75-71.00) to 22.00 (IQR = 11.00-42.00), P &lt; 0.001), and a 74.71% decrease in psychiatric hospital bed days (z = -2.50, P = 0.01). Service-use costs decreased (1 year: -&#163;963/patient (P &lt; 0.001); 2 years: -&#163;1598.10/patient (P &lt; 0.001). Subanalyses for community-only initiation also showed significant cost reductions (1 year: -&#163;827.40/patient (P &lt; 0.001); 2 year: -&#163;1668.50/patient (P &lt; 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 &lt; 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).&lt;bold&gt;Conclusions: &lt;/bold&gt;These findings indicate that community initiation of clozapine is feasible and is associated with significant reductions in costs, service use and symptom severity. [ABSTRACT FROM AUTHOR]
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  Data: &lt;i&gt;Copyright of British Journal of Psychiatry is the property of Cambridge University Press and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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