Centre for Neuropsychiatric Schizophrenia Research, Copenhagen University Hospital, Mental Health Services - Capital Region of Denmark, Glostrup, Nordre Ringvej 29-67, 2600 Glostrup, Denmark.
Eur J Health Econ. 2012 Jun;13(3):355-63. doi: 10.1007/s10198-011-0308-0. Epub 2011 Mar 31.
To investigate the association of antipsychotic polypharmacy in schizophrenia with cost of primary and secondary health service use.
Comparative analysis of health service cost for patients prescribed antipsychotic polypharmacy versus antipsychotic monotherapy. Resource utilisation and costs were described using central Danish registers for a 2 year period (2007-2008). We included patients attached to one of two Danish psychiatric referral centres in 1 January 2008 and/or 1 January 2009. Their prescribed treatment with either antipsychotic polypharmacy or monotherapy at the two cross-sectional dates was recorded and used as proxy of polypharmacy exposure during the preceding year. A multivariate generalised linear model was fitted with total costs of primary and secondary health service use as dependent variable, and antipsychotic polypharmacy, diagnosis, age, gender, disease duration, psychiatric inpatient admissions, and treatment site as covariates.
The sample consisted of 736 outpatients with a diagnosis in the schizophrenia spectrum. Antipsychotic polypharmacy was associated with significantly higher total health service costs compared with monotherapy (2007: 25% higher costs; 2008: 17% higher costs) when adjusting for potential confounders and risk factors. A subgroup analysis suggested that the excessive costs associated with antipsychotic polypharmacy were partly accounted for by the functional level of the patients.
The results demonstrate that antipsychotic co-prescribing is associated with increased use of health care services, even though no causal relations can be inferred from an observational study.
探讨精神分裂症抗精神病药联合用药与初级和二级卫生服务使用成本的关系。
对使用抗精神病药联合用药与抗精神病药单药治疗的患者的卫生服务成本进行比较分析。资源利用和成本使用丹麦中央登记处的数据描述了 2 年（2007-2008 年）的情况。我们纳入了 2008 年 1 月 1 日和/或 2009 年 1 月 1 日附属于丹麦两个精神病转诊中心之一的患者。在这两个横断面日期，记录了他们使用抗精神病药联合用药或单药治疗的情况，并将其作为前一年联合用药暴露的替代指标。使用多元广义线性模型，以初级和二级卫生服务使用的总成本为因变量，以抗精神病药联合用药、诊断、年龄、性别、疾病持续时间、精神科住院治疗和治疗地点为协变量。
该样本包括 736 名诊断为精神分裂症谱系的门诊患者。调整潜在混杂因素和危险因素后，与单药治疗相比，抗精神病药联合用药与总卫生服务成本显著增加相关（2007 年：高出 25%；2008 年：高出 17%）。亚组分析表明，抗精神病药联合用药相关的过高费用部分归因于患者的功能水平。
结果表明，即使从观察性研究中不能推断出因果关系，抗精神病药的联合处方与增加卫生服务的使用有关。
