{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T13:02:18Z","timestamp":1785416538841,"version":"3.56.0"},"reference-count":45,"publisher":"Royal College of Psychiatrists","license":[{"start":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T00:00:00Z","timestamp":1762992000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Br J Psychiatry"],"abstract":"<jats:sec id=\"S0007125025104248_as1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Clozapine is licensed for treatment-resistant schizophrenia (TRS). Because of the risk of clozapine-induced agranulocytosis, its use requires regular haematological monitoring. Substantive evidence supports revisions of absolute neutrophil counts (ANCs) for clozapine discontinuation and ceasing of indefinite haematological monitoring.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125025104248_as2\">\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To examine the cost-effectiveness and budget impact of different haematological monitoring schemes compared with the current UK monitoring practice for patients using clozapine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125025104248_as3\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>We performed a cost-effectiveness and budget impact analysis from the healthcare system perspective over a 3-year period, comparing the current UK clozapine monitoring practice with extended haematological monitoring and a revision of ANC criteria. Costs and quality-adjusted life years (QALYs) were estimated using a semi-Markov model that followed a simulated cohort of 100 000 adults with TRS. Sensitivity analyses were conducted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125025104248_as4\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Extended haematological monitoring would lead to lower mean total costs per patient (6388.34\n                      <jats:italic>v<\/jats:italic>\n                      . 5569.77 GBP) and not compromise quality of life (in QALYs 795.83\n                      <jats:italic>v<\/jats:italic>\n                      . 795.79 days). A revision of ANC criteria for clozapine discontinuation would not substantially lower costs (6388.34\n                      <jats:italic>v<\/jats:italic>\n                      . 6390 GBP), but lead to a slight increase in QALYs (795.83\n                      <jats:italic>v<\/jats:italic>\n                      . 797.08 days), through patients benefitting from longer clozapine treatment. A combination of extended haematological monitoring and revision of ANC criteria would be the dominant strategy, which means that costs are lower (6388.34\n                      <jats:italic>v<\/jats:italic>\n                      . 5548.50 GBP) and QALYs slightly increase (795.83\n                      <jats:italic>v<\/jats:italic>\n                      . 797.03 days) compared with the current UK monitoring practice.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125025104248_as5\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A revision of current UK clozapine monitoring practice would be beneficial from both a clinical and an economic perspective. Adjusting ANC criteria for clozapine cessation avoids unnecessary early discontinuation of clozapine treatment and has a positive impact on quality of life. An extension of monitoring intervals reduces costs borne by the healthcare system. Safety is not compromised by these changes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1192\/bjp.2025.10424","type":"journal-article","created":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T08:46:04Z","timestamp":1763023564000},"page":"1-8","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":2,"title":["Economic evaluation of different haematological monitoring schemes for patients with treatment-resistant schizophrenia using clozapine"],"prefix":"10.1192","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9146-6452","authenticated-orcid":false,"given":"Freya","family":"Diederich","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04ers2y35","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Bremen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1352-4017","authenticated-orcid":false,"given":"Ebenezer","family":"Oloyede","sequence":"additional","affiliation":[{"name":"Maudsley Hospital"},{"name":"University of Oxford"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2557-1710","authenticated-orcid":false,"given":"David","family":"Taylor","sequence":"additional","affiliation":[{"name":"Maudsley Hospital"},{"name":"King\u2019s College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7526-2660","authenticated-orcid":false,"given":"Christian J.","family":"Bachmann","sequence":"additional","affiliation":[{"name":"Ulm University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"170","published-online":{"date-parts":[[2025,11,13]]},"reference":[{"key":"S0007125025104248_ref16","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1996.01830100104013"},{"key":"S0007125025104248_ref24","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.2019.267"},{"key":"S0007125025104248_ref39","doi-asserted-by":"publisher","DOI":"10.1002\/hec.903"},{"key":"S0007125025104248_ref10","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2023.0376"},{"key":"S0007125025104248_ref11","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.2023.44"},{"key":"S0007125025104248_ref17","doi-asserted-by":"publisher","DOI":"10.1038\/s41398-021-01487-4"},{"key":"S0007125025104248_ref18","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.2024.104"},{"key":"S0007125025104248_ref34","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2020.05.014"},{"key":"S0007125025104248_ref21","doi-asserted-by":"publisher","DOI":"10.1111\/acps.12989"},{"key":"S0007125025104248_ref38","doi-asserted-by":"publisher","DOI":"10.2165\/00044011-199815020-00007"},{"key":"S0007125025104248_ref5","doi-asserted-by":"publisher","DOI":"10.1177\/02698811241262767"},{"key":"S0007125025104248_ref25","doi-asserted-by":"publisher","DOI":"10.1186\/1471-244X-8-19"},{"key":"S0007125025104248_ref6","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(22)00188-2"},{"key":"S0007125025104248_ref22","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2016.05.002"},{"key":"S0007125025104248_ref26","unstructured":"26 Hex, N , Retzler, J , Barlett, C , Arber, M. 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Published by Cambridge University Press on behalf of Royal College of Psychiatrists","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}