Gibson P Joseph, Damler Robert, Jackson E Anne, Wilder Teresa, Ramsey Janet L
Health & Hospital Corporation of Marion County, Indianapolis, IN 46285, USA.
Value Health. 2004 Jan-Feb;7(1):22-35. doi: 10.1111/j.1524-4733.2004.71272.x.
The objective of this study was to assess the impact of medication treatment on Medicaid costs for persons with schizophrenia.
Michigan Medicaid claims from January 1995 through September 1998 were analyzed for persons with schizophrenia diagnoses who initiated olanzapine (n = 458), risperidone (n = 481), or haloperidol (n = 252) treatment between January 1996 and September 1997. Total and component Medicaid payments were compared for the year after treatment initiation, with simultaneous adjustment for patient demographics, comorbid conditions, prior medication use, prior service use, and prior year costs.
Significant baseline differences existed between the groups in prior medication and service use. Adherence to index medication varied between the groups (O = 60%; R = 54%; H = 37%; P < =.01 for each pairwise comparison). Average postperiod costs were US dollars 14512 per subject. After baseline adjustment, there were no significant differences in mean total cost. Excluding index medication costs, the olanzapine group's average cost was significantly lower than risperidone (-US dollars 1791, P =.002) and haloperidol (-US dollars 2080, P =.003), whereas the risperidone and haloperidol groups were not significantly different. The differences were driven by significantly lower cost for inpatient services for other medications among the olanzapine group.
Total costs of schizophrenia care associated with olanzapine, risperidone, or haloperidol were similar, but component costs differed. Relative to risperidone or haloperidol, olanzapine may have a higher acquisition cost, but may decrease inpatient costs and be associated with more optimal medication use patterns. Use of risperidone may also increase pharmacy costs and be associated with greater persistence, relative to haloperidol.
本研究的目的是评估药物治疗对精神分裂症患者医疗补助费用的影响。
分析了1995年1月至1998年9月密歇根州医疗补助申请记录，这些记录来自于1996年1月至1997年9月期间开始使用奥氮平（n = 458）、利培酮（n = 481）或氟哌啶醇（n = 252）进行治疗的精神分裂症患者。比较了治疗开始后一年的医疗补助总支付和分项支付情况，并同时对患者人口统计学特征、合并症、既往用药情况、既往服务使用情况和上一年费用进行了调整。
各组在既往用药和服务使用方面存在显著的基线差异。各组对索引药物的依从性有所不同（奥氮平组 = 60%；利培酮组 = 54%；氟哌啶醇组 = 37%；每对比较P <=.01）。治疗期后的平均费用为每位受试者14512美元。经过基线调整后，平均总费用没有显著差异。排除索引药物费用后，奥氮平组的平均费用显著低于利培酮组（-1791美元，P =.002）和氟哌啶醇组（-2080美元，P =.003），而利培酮组和氟哌啶醇组之间没有显著差异。这些差异是由奥氮平组其他药物的住院服务费用显著降低所驱动的。
与奥氮平、利培酮或氟哌啶醇相关的精神分裂症护理总费用相似，但分项费用有所不同。相对于利培酮或氟哌啶醇，奥氮平可能采购成本更高，但可能会降低住院费用，并与更优化的用药模式相关。相对于氟哌啶醇，使用利培酮也可能增加药房费用，并与更高的持续性相关。
