Sun Shawn X, Liu Gordon G, Christensen Dale B, Fu Alex Z
Health Outcomes Department, Walgreens Health Services, Deerfield, IL, USA.
Curr Med Res Opin. 2007 Oct;23(10):2305-12. doi: 10.1185/030079907X226050.
To review the literature addressing the economic outcomes of nonadherence in the treatment of schizophrenia, and to utilize the review results to provide an update on the economic impact of hospitalizations among schizophrenia patients related to antipsychotic nonadherence.
A structured search of EMBASE, Ovid MEDLINE, PubMed and PsycINFO for years 1995-2007 was conducted to identify published English-language articles addressing the economic impact of antipsychotic nonadherence in schizophrenia. The following key words were used in the search: compliance, noncompliance, adherence, nonadherence, relapse, economic, cost, and schizophrenia. A bibliographic search of retrieved articles was performed to identify additional studies. For a study to be included, the date of publication had to be from 1/1/1995 to 6/1/2007, and the impact of nonadherence had to be measured in terms of direct healthcare costs or inpatient days. Subsequently, an estimate of incremental hospitalization costs related to antipsychotic non adherence was extrapolated at the US national level based on the reviewed studies (nonadherence rate and hospitalization rate) and the National Inpatient Sample of Healthcare Cost and Utilization Project (average daily hospitalization costs).
Seven studies were identified and reviewed based on the study design, measurement of medication nonadherence, study setting, and cost outcome results. Despite the varied adherence measures across studies, all articles reviewed showed that antipsychotic nonadherence was related to an increase in hospitalization rate, hospital days or hospital costs. We also estimated that the national rehospitalization costs related to antipsychotic nonadherence was $1479 million, ranging from $1392 million to $1826 million in the US in 2005.
The estimate of rehospitalization costs was restricted to schizophrenia patients from the Medicaid program. Additionally, the studies we reviewed did not capture the newer antipsychotic drugs (ziprasidone, aripiprazole and paliperidone). Thus, the nonadherence rates or rehospitalization rates might have changed after these new drugs came to the market, which could limit our cost estimation.
Poor adherence to antipsychotic medications was consistently associated with higher risk of relapse and rehospitalization and higher hospitalization costs. To reduce the cost of hospitalizations among schizophrenia patients, it seems clear that efforts to increase medication adherence should be undertaken.
回顾关于精神分裂症治疗中不依从性的经济后果的文献，并利用回顾结果更新与抗精神病药物不依从性相关的精神分裂症患者住院的经济影响。
对1995年至2007年期间的EMBASE、Ovid MEDLINE、PubMed和PsycINFO进行结构化检索，以识别已发表的关于精神分裂症中抗精神病药物不依从性的经济影响的英文文章。检索中使用了以下关键词：依从性、不依从性、坚持、不坚持、复发、经济、成本和精神分裂症。对检索到的文章进行文献检索以识别其他研究。要纳入一项研究，发表日期必须为1995年1月1日至2007年6月1日，且不依从性的影响必须根据直接医疗成本或住院天数来衡量。随后，根据回顾的研究（不依从率和住院率）以及医疗成本和利用项目的国家住院样本（平均每日住院成本），在美国国家层面推断与抗精神病药物不依从性相关的住院成本增量估计值。
根据研究设计、药物不依从性的测量、研究环境和成本结果，识别并回顾了七项研究。尽管各研究中的依从性测量方法各不相同，但所有回顾的文章都表明，抗精神病药物不依从性与住院率、住院天数或住院成本的增加有关。我们还估计，2005年在美国，与抗精神病药物不依从性相关的全国再住院成本为14.79亿美元，范围在13.92亿美元至18.26亿美元之间。
再住院成本的估计仅限于医疗补助计划中的精神分裂症患者。此外，我们回顾的研究未涵盖更新的抗精神病药物（齐拉西酮、阿立哌唑和帕利哌酮）。因此，这些新药上市后，不依从率或再住院率可能已经发生变化，这可能会限制我们的成本估计。
抗精神病药物依从性差一直与复发和再住院风险较高以及住院成本较高相关。为降低精神分裂症患者的住院成本，显然应努力提高药物依从性。
