Gilmer Todd P, Dolder Christian R, Folsom David P, Mastin William, Jeste Dilip V
Department of Family and Preventive Medicine, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA 92093-0622, USA.
Psychiatr Serv. 2007 Jul;58(7):1007-10. doi: 10.1176/ps.2007.58.7.1007.
This study examined trends and costs of second-generation antipsychotic polypharmacy among Medicaid beneficiaries with schizophrenia in San Diego County.
Medicaid data were used to identify 15,962 persons with schizophrenia receiving antipsychotic medications between 1999 and 2004. The yearly proportion of beneficiaries receiving second-generation antipsychotic polypharmacy, duration of polypharmacy, inpatient admissions, and pharmaceutical costs were examined.
The proportion of clients receiving second-generation antipsychotic polypharmacy increased from 3.3% in 1999 to 13.7% in 2004, whereas annual antipsychotic medication costs increased from $4,128 to $5,231 (2004 dollars). Among those receiving second-generation polypharmacy, the percentage receiving second-generation polypharmacy for 12 months increased from 5.1% to 14.4%, and the percentage hospitalized increased from 7.2% to 9.0%.
The prevalence of long-term second-generation antipsychotic polypharmacy and its associated costs increased substantially between 1999 and 2004. Prescribing antipsychotic polypharmacy is an unproven and costly strategy that if left unchanged could lead to administrative efforts to cut costs and dictate practice.
本研究调查了圣地亚哥县医疗补助计划中患有精神分裂症的受益人使用第二代抗精神病药物联合治疗的趋势及成本。
利用医疗补助计划数据，识别出1999年至2004年间15962名接受抗精神病药物治疗的精神分裂症患者。对接受第二代抗精神病药物联合治疗的受益人的年度比例、联合治疗持续时间、住院次数及药品成本进行了调查。
接受第二代抗精神病药物联合治疗的患者比例从1999年的3.3%增至2004年的13.7%，而年度抗精神病药物成本从4128美元增至5231美元（按2004年美元计算）。在接受第二代联合治疗的患者中，接受第二代联合治疗达12个月的比例从5.1%增至14.4%，住院比例从7.2%增至9.0%。
1999年至2004年间，长期使用第二代抗精神病药物联合治疗的患病率及其相关成本大幅增加。开具抗精神病药物联合治疗处方是一种未经证实且成本高昂的策略，若不改变，可能会导致为削减成本而进行行政干预并影响医疗实践。
