Mladsi Deirdre M, Grogg Amy L, Irish William D, Lopez Rebecca B, Degen Kathleen, Swann Alan, Nimsch Christian T
RTI-Health Solutions, RTI International, Research Triangle Park, NC 27709, USA.
Curr Med Res Opin. 2004 Dec;20(12):1883-93. doi: 10.1185/030079904X11510.
This study examines total pharmacy cost and usage patterns of schizophrenic patients in acute mental health inpatient settings for three atypical antipsychotics -- risperidone, olanzapine, and quetiapine. Despite the readily available unit cost information for drugs, actual pharmacy costs may deviate significantly from 'labeled costs'. Recent research findings indicate the need for more robust evaluation of such pharmacy costs.
This study used data from non-randomized inpatient retrospective charts from three acute care inpatient mental health facilities. The final pooled sample included 327 patients, of which 120 received risperidone, 153 received olanzapine, and 54 received quetiapine. Medication cost was defined as the average wholesale price (AWP) as listed in the 2001 'Red Book'. Propensity scoring methodology and multinomial regression were employed to reduce treatment selection bias.
The observed mean daily antipsychotic drug doses were 4.45 mg (SD 2.44) for risperidone, 14.04 mg (SD 5.55) for olanzapine, and 350.33 mg (SD 228.24) for quetiapine. The corresponding mean daily drug costs were $7.66(SD $4.20) for risperidone, $8.11 (SD $5.29) for quetiapine and, $12.10 (SD $4.79) for olanzepine. Numbers adjusted for treatment selection bias show that the average daily total pharmacy cost of risperidone was $4.35 lower than olanzapine (p < 0.001) and $1.41 lower than quetiapine (p = 0.38). The adjusted average daily pharmacy cost of olanzapine was $4.02 higher than quetiapine (p < 0.001). After statistical adjustment there were no significant differences between study drugs in terms of length of stay or patient functioning.
This study provides the first US comparison of medication utilization patterns and pharmacy costs for olanzapine, risperidone, and quetiapine administered in acute mental health care inpatient settings. While this study did not estimate the full economic value of the three antipsychotics in these inpatient settings, it demonstrated that the mean daily costs for risperidone were lower than the mean daily costs for olanzapine (p < 0.001) and quetiapine although the later difference was not statistically significant (p = 0.38).
本研究调查了三种非典型抗精神病药物——利培酮、奥氮平和喹硫平在急性精神科住院环境中用于精神分裂症患者的总体药房成本及使用模式。尽管药物的单位成本信息易于获取，但实际药房成本可能与“标价成本”有显著差异。最近的研究结果表明，需要对这类药房成本进行更全面的评估。
本研究使用了来自三家急性护理住院精神科机构的非随机住院患者回顾性病历数据。最终汇总样本包括327名患者，其中120人接受利培酮治疗，153人接受奥氮平治疗，54人接受喹硫平治疗。药物成本定义为2001年《红皮书》中列出的平均批发价（AWP）。采用倾向评分法和多项回归分析以减少治疗选择偏倚。
观察到的每日抗精神病药物平均剂量为：利培酮4.45毫克（标准差2.44），奥氮平14.04毫克（标准差5.55），喹硫平350.33毫克（标准差228.24）。相应的每日药物平均成本为：利培酮7.66美元（标准差4.20美元），喹硫平8.11美元（标准差5.29美元），奥氮平12.10美元（标准差4.79美元）。经治疗选择偏倚调整后的数字显示，利培酮的每日药房总成本平均比奥氮平低4.35美元（p<0.001），比喹硫平低1.41美元（p = 0.38）。奥氮平调整后的每日药房平均成本比喹硫平高4.02美元（p<0.001）。经统计调整后，研究药物在住院时间或患者功能方面没有显著差异。
本研究首次对美国急性精神科住院环境中奥氮平、利培酮和喹硫平的药物使用模式和药房成本进行了比较。虽然本研究未估计这三种抗精神病药物在这些住院环境中的全部经济价值，但研究表明，利培酮的每日平均成本低于奥氮平（p<0.001）和喹硫平，尽管后者的差异无统计学意义（p = 0.38）。
