Clozapine is effective in treating patients with schizophrenia who do not respond to conventional neuroleptic drugs.
The drug is unique in that it is available only with a US Food and Drug Administration-mandated system for weekly monitoring of patients'white blood cell counts.
No study has been conducted to evaluate the cost-effectiveness of this mandatory monitoring system.
A benchmark case was established by utilizing cumulative incidence rates of agranulocytosis from a recent study with a large sample of clozapine-treated patients.
We assumed a 20% mortality among patients with agranulocytosis, $30.61 in monitoring costs each week, and 14.4 years of remaining life expectancy after detection of agranulocytosis.
Based on these benchmark assumptions, cost-effectiveness ratios in dollars per quality-adjusted life-year were calculated for the first, second, and third 6-month periods during which a patient was receiving clozapine.
Sensitivity analyses were performed with more conservative assumptions in 5 alternative scenarios.
In the benchmark case, costs per quality-adjusted life-year gained were $61 694, $925 418, and $420 644 for the first, second, and third 6-month periods of clozapine treatment, respectively.
In the alternative scenarios, these costs ranged from $7923 to $46 056 for the first 6-month period and from $54 025 to $690 850 for the second and third 6-month periods. (...)
Mots-clés Pascal : Schizophrénie, Psychose, Chimiothérapie, Clozapine, Neuroleptique, Psychotrope, Surveillance biologique, Analyse coût, Durée, Economie santé, Etude longitudinale, Homme
Mots-clés Pascal anglais : Schizophrenia, Psychosis, Chemotherapy, Neuroleptic, Psychotropic, Biological monitoring, Cost analysis, Duration, Health economy, Follow up study, Human
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 96-0473694
Code Inist : 002B02B03. Création : 10/04/1997.