Division of Pharmaceutical Outcomes and Policy, University of North Carolina School of Pharmacy, Chapel Hill, North Carolina, USA.
Appl Health Econ Health Policy. 2010;8(3):167-77. doi: 10.2165/11318830-000000000-00000.
A large body of clinical studies have demonstrated the efficacy of atypical antipsychotic use in the treatment of bipolar disorder. Facing increasing budget pressure, third-party payers, such as state Medicaid programmes in the US, are demanding better understanding of the medical costs beyond atypical antipsychotic drug costs alone in treating bipolar disorder.
To examine healthcare costs associated with the atypical antipsychotic treatments for bipolar disorder from a US third-party payer perspective.
This was a retrospective cohort study using an intent-to-treat approach. Using the North Carolina Medicaid claims database (August 2000 to January 2005), 3328 patients with bipolar disorder were identified who were continuously eligible for 3 months pre-initiation and 12 months post-initiation of treatment with an atypical antipsychotic (AP2) or mood stabilizer (MS). Patients were classified into three groups based on the treatment types during the first 30 days after treatment initiation: AP2 monotherapy, AP2 + MS combination therapy, and MS monotherapy. Bipolar-related and total health-related costs were examined for the 12-month period. Propensity score matching was employed to balance baseline characteristics among the three comparison groups. Generalized linear models were further employed to estimate the average treatment effect on the cost outcomes.
Compared with MS monotherapy, AP2 monotherapy and AP2 + MS combination therapy incurred higher medication costs during the 12-month treatment period. Patients receiving AP2 monotherapy had significantly lower bipolar-related medical costs (-$US698; p = 0.002) [year 2004 values] than patients receiving MS monotherapy. However, the inclusion of the medication cost produced no statistically significant difference in bipolar-related total cost (p = 0.14). Similar results were observed for all health-related costs. Patients receiving AP2 + MS therapy incurred significantly higher bipolar-related total costs (+$US1659; p < 0.0001) and all health-related total costs (+$US2115; p < 0.0001) than patients receiving MS monotherapy, which was attributable largely to the higher medication cost.
From a third-party payer perspective, atypical antipsychotic monotherapy generated higher drug costs but lower medical care costs, resulting in equivalent total healthcare costs over a 1-year period.
大量临床研究表明，非典型抗精神病药物在治疗双相情感障碍方面具有疗效。面对日益增长的预算压力，第三方付款人（如美国的州医疗补助计划）要求在治疗双相情感障碍时，除了非典型抗精神病药物成本外，还要更好地了解医疗成本。
从美国第三方付款人的角度检查治疗双相情感障碍的非典型抗精神病药物相关的医疗保健费用。
这是一项回顾性队列研究，采用意向治疗方法。使用北卡罗来纳州医疗补助索赔数据库（2000 年 8 月至 2005 年 1 月），确定了 3328 名符合条件的双相情感障碍患者，他们在开始使用非典型抗精神病药物（AP2）或情绪稳定剂（MS）治疗前的 3 个月内和治疗后 12 个月内连续有资格获得治疗。根据治疗开始后 30 天内的治疗类型，将患者分为三组：AP2 单药治疗、AP2 + MS 联合治疗和 MS 单药治疗。在 12 个月期间检查了与双相情感障碍相关的和总健康相关的成本。采用倾向评分匹配平衡三组比较的基线特征。进一步采用广义线性模型估计对成本结果的平均治疗效果。
与 MS 单药治疗相比，AP2 单药治疗和 AP2 + MS 联合治疗在 12 个月的治疗期间药物费用更高。接受 AP2 单药治疗的患者与接受 MS 单药治疗的患者相比，与双相情感障碍相关的医疗费用显著降低（-698 美元；p=0.002）[2004 年值]。然而，包括药物成本在内，在与双相情感障碍相关的总费用方面没有统计学上的显著差异（p=0.14）。所有与健康相关的费用也观察到了类似的结果。接受 AP2 + MS 治疗的患者与接受 MS 单药治疗的患者相比，与双相情感障碍相关的总费用（+1659 美元；p<0.0001）和所有与健康相关的总费用（+2115 美元；p<0.0001）显著升高，这主要归因于药物成本更高。
从第三方付款人的角度来看，非典型抗精神病药物单药治疗产生了更高的药物成本，但医疗费用更低，因此在 1 年内产生了等效的总医疗保健成本。
