Johnson & Johnson Pharmaceutical Services, Raritan, NJ 08869, USA.
Curr Med Res Opin. 2010 Apr;26(4):943-55. doi: 10.1185/03007991003658956.
BACKGROUND: Inpatient care to manage relapse of patients with schizophrenia contributes greatly to the overall financial burden of treatment. The present study explores to what extent this is influenced by duration of illness. METHODS: Medical and pharmaceutical claims data for patients diagnosed with schizophrenia (ICD-9 295.xx) were obtained from the PharMetrics Integrated Database, a large, regionally representative US insurance claims database, for the period 1998-2007. Recently diagnosed (n = 970) and chronic patients (n = 2996) were distinguished based on ICD-9 295.xx classification, age and claims history relative to the first year (recently diagnosed) and the third year onwards (chronic) after the first index schizophrenia event. RESULTS: The medical resource use and costs during the year following the index schizophrenia event differed significantly between cohorts. A higher proportion of recently diagnosed patients were hospitalised compared with chronic patients (22.3% vs 12.4%; p < 0.0001), spending a greater mean number of days in hospital (5.1 days vs 3.0 days; p = 0.0065) as well as making more frequent use of emergency room (ER) resources during this time. The mean annual healthcare costs of recently diagnosed patients were also greater ($20,654 vs $15,489; p < 0.0001) with inpatient costs making up a higher proportion of total costs (62.9%) compared with chronic patients (38.5%). CONCLUSIONS: There is a considerably higher overall economic burden in the year following their first schizophrenia event in the treatment of recently diagnosed schizophrenia patients compared with chronic patients. Since hospitalisations and ER visits are the most significant components contributing to this finding, efforts that focus on measures to reduce the risk of relapse, particularly amongst recently diagnosed patients, such as improved adherence programs, may lead to better clinical and economic outcomes in the management of schizophrenia. LIMITATIONS: Only commercially insured patients and direct medical costs were included, therefore, results may underestimate the economic burden of schizophrenia.
背景：住院治疗精神分裂症患者的复发对治疗的总体经济负担有很大影响。本研究旨在探讨疾病持续时间在多大程度上对此产生影响。
方法：从 PharMetrics 综合数据库（一个大型的、具有区域代表性的美国保险索赔数据库）中获取了在 1998 年至 2007 年期间被诊断患有精神分裂症（ICD-9 295.xx）的患者的医疗和药品索赔数据。根据 ICD-9 295.xx 分类、年龄以及与第一年（最近确诊）和第三年（慢性）之后与首次精神分裂症事件相关的索赔记录，将最近确诊（n=970）和慢性（n=2996）患者区分开来。
结果：在索引精神分裂症事件后的一年内，两组患者的医疗资源使用情况和费用有显著差异。与慢性患者相比，最近确诊患者的住院比例更高（22.3% vs 12.4%；p<0.0001），住院天数更多（5.1 天 vs 3.0 天；p=0.0065），急诊室（ER）资源使用频率更高。在此期间，最近确诊患者的年平均医疗保健费用也更高（$20654 比 $15489；p<0.0001），住院费用占总费用的比例（62.9%）高于慢性患者（38.5%）。
结论：与慢性患者相比，最近确诊精神分裂症患者在首次精神分裂症事件后的第一年治疗中，整体经济负担明显更高。由于住院和 ER 就诊是导致这一发现的最主要因素，因此，关注减少复发风险的措施，特别是针对最近确诊患者的措施，如改善依从性计划，可能会改善精神分裂症的管理效果和经济效益。
局限性：仅纳入了商业保险患者和直接医疗费用，因此，结果可能低估了精神分裂症的经济负担。
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