Cost-benefit analysis of risperidone and clozapine in the treatment of schizophrenia in Israel

In this study, the benefits and costs of treating schizophrenia with either risperidone or clozapine were examined. The lifetime drug-treatment cost incurred by a patient with schizophrenia in Israel was $US7561 (1996 values) with an initial 6-month trial with risperidone, compared with $US6326 with clozapine and $US3360 with typical antipsychotics. Total lifetime costs of psychiatric health services (excluding medications) by individuals who were continuously receiving typical antipsychotics were $US 181 555 per patient. Assuming a 6.3% decrease in hospital use with typical antipsychotics and an absolute 30% decrease with risperidone or clozapine, the use of clozapine or risperidone reduced hospitalisation costs by $US7159 per patient, but increased community-care costs by $US1627 per patient, giving health-service benefit: cost ratios of 1.87 : 1 and 1.32 : 1, respectively. After adding indirect benefits resulting from increased work productivity (minus indirect costs related to increases in transport costs because of visits for blood monitoring during clozapine therapy), the benefit : cost ratios increased to 2.04 : 1 and 1.48 : 1, respectively. Assuming that clozapine caused a 30% decrease in hospital use by patients with new-onset schizophrenia, risperidone would have to decrease hospital use by 43.2% (i.e. a 13.2% relative advantage) for its societal benefits to justify its increased costs.