Reference no: EM132254051

Clozapine (Clozaril) is a drug manufactured by Sandoz for the treatment of severe chronic schizophrenics who are unresponsive to regular treatments. One study indicates that after a year of treatment 68 percent of the treatment-resistant patients were improved. In another study, 55 percent of those improved were able to work or go to school, and readmissions to the mental hospital were reduced by 88 percent (Meltze et al., 1990, p. 892). A third study (Eichelman and Hartwig, 1990) in a state mental hospital showed that over two years the new treatment saved the state $20,000 a year per patient. In addition, clozapine has a low incidence of side effects, such as tardive dyskinesia, associated with other drugs for schizophrenics. It can, however, produce seizures and tachycardia, which can cause individuals to refuse further treatment. Unfortunately, unless constantly monitored, the drug often produces damage to the bone marrow, reducing immunity and exposing patients to all sorts of infection and even death. The proper use of the drug demands weekly blood tests of peripheral white cell counts. As a result, in the United States the combination of drug and tests costs $8,944 per person per year for the remainder of the patient's life. One study estimates that it would cost $1.2 billion a year to treat the 133,000 patients defined as eligible for the drug (Terkelsen and Grosser, 1990, p. 866).

If the use of the drug is extended to groups other than the eligible group, Terkelsen and Grosser (1990, p. 867) estimate that 186,000 patients could benefit. Under these assumptions, the treatment could cost $1.7 billion a year. The fact that most eligible patients are indigent makes these figures all the more significant.

Part of the cost seems to be explained by the fact that the manufacturers have insisted that the drug and tests be bought as a package, with the tests being administered by a for-profit home health company, Caremark, Inc. Many professionals feel that the price of the package or system is excessive and that there is good evidence both here and in England that the testing can be done by other laboratories (Reid, 1990). Sandoz later agreed to sell the drug aside from the whole package.

Do ethics demand that clozapine be authorized for all patients on medical assistance and all patients in state mental institutions? Are additional studies on cost savings necessary? Which principles are to be used here? Why? In answering the questions that follow, it will be well to ask what additional information would be useful or necessary to be more confident of the answer and then push for a decision on the basis of what is known.

Is this drug part of basic adequate care or is it, because of cost, a non- basic treatment? In answering this question, weigh the monetary costs, the side effects, and the fact that much of the drug will be wasted since a fairly high percentage will abandon the treatment. If it is basic, should the law stop Sandoz from increasing costs by insisting on its Patient Management System? Will the decrease in readmissions to mental hospitals and the return to the work force of a significant number of patients offset the costs of the treatment? If there must be a rationing scheme because the resources are limited, what should be the basis of that rationing since we do not know ahead of time who will benefit from the treatment? Can you think of other areas where the same expenditure would help more people and give a greater return to society? Discuss prenatal care, breast cancer prevention, free inoculations for children on medical assistance, alcohol and drug rehabilitation, and antismoking campaigns.