RESUMO
Schizophrenia disorders afflict approximately 1% of the population during their lifetime. Conventional antipsychotic agents show therapeutic limitations because of their side-effects and inefficacy among some patients. A novel antipsychotic class, named atypical neuroleptics, among Léponex is the leader, constitutes a hope in treatment-resistant schizophrenia. However, because the drug involves a 1% to 2% risk of agranulocytosis, an haematological oversees has been established. Moreover, the acquisition cost of clozapine is high in comparison with that of standard antipsychotics. The purpose of this study was to observe the management of 72 patients suffering from resistant schizophrenia, to assess the cost of this treatment in medical and social terms, and to realize cost-effectiveness study in Charles Perrens Hospital (Bordeaux). The survey based on three questionnaires (Clinical informations, Quality of Life, Epidemiological information) was sent to psychiatrists practising in this hospital. The results confirm efficacy (overall functioning measured by CGI which is significant, p < 0.0001) and tolerance of Léponex (no side effects in 33.3% patients, no agranulocytosis, only one neutropenia and only 4.2% neurologic side effects). We found a significant reduction of the annual mean number of days of full time hospitalization (214 days versus 135 after two years, p < 0.0005) associated with the significant reduction of direct cost mainly related to shorter length of hospitalization; and 45.8% versus 8.3% adjust to life in the community (p < 0.0004). Clozapine produced a marked improvement (p < 0.0001) in Quality of Life measured by two self-rating scales (SWN and TEAQV). The estimated total two-years cost decreased from 31,108 Francs/month/patient to 22,950 Francs/month/patient, a saving of 8,158 Francs/month/patient (a decrease of 26.2%). Although the acquisition cost of clozapine is high, cost effectiveness estimates in patients with treatment resistant schizophrenia suggest that the clinical benefits (improved psychopathology, social functioning and quality of life) of this drug may confer medium to long term economic benefits, primarily by reducing the need for psychiatric hospital service.