Faries Douglas E, Ascher-Svanum Haya, Nyhuis Allen W, Kinon Bruce J
US Statistics, Lilly USA, LLC, Indianapolis, IN, USA.
BMC Psychiatry. 2009 Sep 2;9:54. doi: 10.1186/1471-244X-9-54.
Switching between antipsychotic medications is common in the treatment of schizophrenia. However, data on clinical and economic outcomes from antipsychotic switching, in particular acute care service use, is fairly limited. The goal of this research was to assess the clinical and economic ramifications of switching antipsychotics during outpatient management of schizophrenia.
Data from a 1-year randomized, open-label cost-effectiveness study involving typical and atypical antipsychotics were assessed. The study protocol permitted switching of antipsychotics when clinically warranted. The risk of crisis-related events, use of acute-care services, and the time to the initial use of such services were determined in outpatients who switched antipsychotics compared with those who continued with their initial medications. Health care resource utilization data were abstracted from medical records and other sources (e.g., patient self-report), and direct costs were estimated using previously published benchmarks.
Almost one-third of patients (29.3%) underwent a switch from their initial antipsychotic agent, with an average duration of 100 days before such treatment alterations. Compared with their counterparts who remained on their initial therapies, individuals who switched antipsychotics experienced a significantly higher risk of acute-care services, including hospitalization (p = .013) and crisis services (p = .011). Patients undergoing medication switches also used acute-care services significantly sooner (p = .004) and accrued an additional $3,000 (a 25% increase) in annual total health care costs per patient, most of which was due to acute-care expenditures.
Switching antipsychotic medications was found to be associated with considerably poorer clinical and economic outcomes, as reflected by, more frequent and more rapid use of acute-care services compared with persons remaining on their initial treatments.
Trial ID 2325 in LillyTrials.com (also accessible via ClinicalStudyResults.org).
在精神分裂症治疗中，更换抗精神病药物的情况很常见。然而，关于抗精神病药物更换后的临床和经济结果的数据，尤其是急性护理服务的使用情况，相当有限。本研究的目的是评估在精神分裂症门诊管理期间更换抗精神病药物的临床和经济影响。
评估了一项为期1年的随机、开放标签成本效益研究的数据，该研究涉及典型和非典型抗精神病药物。研究方案允许在临床需要时更换抗精神病药物。与继续使用初始药物的门诊患者相比，确定了更换抗精神病药物的门诊患者发生危机相关事件的风险、急性护理服务的使用情况以及首次使用此类服务的时间。医疗保健资源利用数据从医疗记录和其他来源（如患者自我报告）中提取，直接成本使用先前公布的基准进行估算。
近三分之一的患者（29.3%）从初始抗精神病药物换药，此类治疗改变前的平均持续时间为100天。与继续使用初始治疗的患者相比，更换抗精神病药物患者使用急性护理服务的风险显著更高，包括住院（p = 0.013）和危机服务（p = 0.011）。换药患者使用急性护理服务的时间也显著更早（p = 0.004），且每位患者每年的总医疗保健成本额外增加3,000美元（增加25%），其中大部分是由于急性护理支出。
与继续使用初始治疗的患者相比，更换抗精神病药物与明显更差的临床和经济结果相关，表现为更频繁、更快地使用急性护理服务。
LillyTrials.com上的试验编号2325（也可通过ClinicalStudyResults.org访问）。
