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statistical significance. It was therefore concluded that clozapine produced better outcomes (on some, but not all measures, of effectiveness) at an equivalent cost, and was consequently more cost-effective than usual care. This study by Essock et al. [187] is unusual in this field for the breadth of its cost and effectiveness measurements, and the rigour of its analytical methods.

A different conclusion was reached by Sernyak et al. [188] in their matched comparison of patients treated with clozapine or FGAM  in a naturalistic setting in the US. Clozapine patients had relatively more in-patient days in the three years after discharge from the hospital (where the study commenced), leading the authors to suggest that this treatment with this SGAM may actually be more costly than treatment with conventional medications (although this proposition was not actually tested).

Rehospitalisation rates were examined by Rabinowitz et al. [189] for patients with schizophrenia who were discharged from in-patient psychiatric facilities in Israel. Two years after discharge, half the patients discharged while taking a conventional antipsychotic drug remained in the community, compared to two-thirds of patients treated with risperidone or olanzapine.

Systematic reviews of evidence on depot preparations of conventional antipsychotic drugs have been published recently. Although depot administration has advantages over oral administration of conventional treatments for patients who are not well engaged with services or do not take their oral medication regularly, the international evidence on effectiveness is mixed [190,191].  The cost-effectiveness evidence is very sparse indeed, and of questionable quality, making it difficult to draw firm conclusions [192].  However, the non-concordance problem that may have led to the prescription of a depot medication generates potentially major challenges for research in this area: patients who do not take their oral medication may also be hard to recruit into, or retain, in trials.

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