Romeo R, Knapp M, Tyrer P, Crawford M, Oliver-Africano P
Centre for the Economics of Mental Health, King's College London, Institute of Psychiatry, London, UK.
J Intellect Disabil Res. 2009 Jul;53(7):633-43. doi: 10.1111/j.1365-2788.2009.01180.x. Epub 2009 May 21.
Antipsychotic drugs are used in the routine treatment of adults with intellectual disabilities (ID) and challenging behaviour in the UK despite limited evidence of their effectiveness. There is no evidence on their cost-effectiveness.
The relative cost-effectiveness of risperidone, haloperidol and placebo in treating individuals with an ID and challenging behaviour was compared from a societal perspective in a 26-week, double-blind, randomised controlled trial. Outcomes were changes in aggression and quality of life. Costs measured all service impacts and unpaid caregiver inputs.
After 26 weeks, patients randomised to placebo had lower costs compared with those in the risperidone and haloperidol treatment groups. Aggression was highest for patients treated with risperidone and lowest for patients treated with haloperidol; however, quality of life was lowest for patients treated with haloperidol and highest for patients treated with risperidone.
The treatment of challenging behaviour in ID with antipsychotic drugs is not a cost-effective option.
在英国，抗精神病药物用于患有智力障碍（ID）且有挑战性行为的成年人的常规治疗，尽管其有效性证据有限。尚无关于其成本效益的证据。
在一项为期26周的双盲随机对照试验中，从社会角度比较了利培酮、氟哌啶醇和安慰剂治疗患有ID且有挑战性行为个体的相对成本效益。结果指标为攻击性和生活质量的变化。成本衡量了所有服务影响和无薪照料者投入。
26周后，随机分配到安慰剂组的患者与利培酮和氟哌啶醇治疗组相比成本更低。接受利培酮治疗的患者攻击性最高，接受氟哌啶醇治疗的患者攻击性最低；然而，接受氟哌啶醇治疗的患者生活质量最低，接受利培酮治疗的患者生活质量最高。
使用抗精神病药物治疗ID中的挑战性行为并非具有成本效益的选择。
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