Initiating clozapine in the outpatient setting: A retrospective study examining the cost-effectiveness,feasibility and safety

Abstract

Aim

Evidence supporting an outpatient initiation model for clozapine is lacking and would add to prescriber, service and consumer confidence in the safety and benefits of this approach. Our study aims to determine whether outpatient initiation and titration of clozapine is feasible, safe and cost-effective in Australia.

Methods

We retrospectively identified 27 consumers aged 18–65 admitted to our service between 2007 and 2019 for day initiation and outpatient titration of clozapine. We collected demographic and clinical data from medical records including diagnosis, adverse drug reactions, hospitalisations and adherence. We compared costs over the initial fortnight of initiating clozapine through our outpatient model versus an inpatient admission for schizophrenia of equivalent duration using local standardised costing data.

Results

We demonstrated that the cost differential between our model for clozapine initiation in the outpatient setting versus an inpatient admission was $24421.96 per patient over the first fortnight. Adherence, side effects and safety, including access to hospitalisation as needed, were comparable to prior studies.

Conclusions

Clozapine initiation in an outpatient setting is likely to produce significant cost savings whilst being feasible and safe. There were no appreciable effects on treatment adherence or adverse drug reactions. Limitations include a small sample size and retrospective methodology.