Revicki D A
Center for Health Outcomes Research, MEDTAP International, Bethesda, Maryland 20814, USA.
J Clin Psychiatry. 1999;60 Suppl 1:7-11; discussion 28-30.
Cost-effectiveness analyses determine whether a new therapy will find a place in clinical practice, based on the cost of its use and the health outcomes it produces, compared with other available therapies. Clozapine, indicated for treatment-resistant schizophrenia, has been evaluated in uncontrolled, mirror-image studies; clinical decision analysis models; and prospective, randomized clinical trials. Results from randomized trials demonstrate that clozapine controls symptoms of psychopathology and improves quality of life slightly more effectively than traditional neuroleptic medications. It has a lower incidence of extrapyramidal side effects than traditional medications, resulting in a lower drop-out rate. Beginning in the second year of treatment, clozapine may produce cost savings for the health care system, when its higher acquisition cost begins to be offset by reduced hospitalization. Mirror-image studies and clinical decision analysis models provide further support for these findings.
成本效益分析根据新疗法的使用成本及其产生的健康结果，并与其他可用疗法相比较，来确定该新疗法是否能在临床实践中占有一席之地。氯氮平被用于治疗难治性精神分裂症，已在非对照、镜像研究、临床决策分析模型以及前瞻性随机临床试验中得到评估。随机试验结果表明，与传统抗精神病药物相比，氯氮平能更有效地控制精神病理症状并略微改善生活质量。它的锥体外系副作用发生率低于传统药物，从而使脱落率更低。从治疗的第二年开始，氯氮平较高的购置成本开始被住院费用的减少所抵消，这可能会为医疗保健系统节省成本。镜像研究和临床决策分析模型为这些发现提供了进一步的支持。
