Health Economics Resource Center, VA Cooperative Studies Program, VA Palo Alto Health Care System, Menlo Park, CA 94025, USA.
J Clin Psychiatry. 2012 May;73(5):696-702. doi: 10.4088/JCP.11m07070.
The effect of long-acting injectable (LAI) risperidone on health care costs was determined in a multisite clinical trial.
Veterans Health Administration patients with unstable schizophrenia or schizoaffective disorder established by the Structured Clinical Interview for DSM-IV (N = 369) were randomized between 2006 and 2009 to long-acting risperidone or physician's choice of oral antipsychotic. Health care utilization and cost were tracked in administrative data. Medication administered by the trial was recorded on case report forms. Medication cost was based on unit costs to the US Medicaid program. Economic outcomes were assessed with the Quality of Well-Being instrument.
Participants randomized to LAI risperidone (n = 187) incurred $14,916 per quarter in total health care costs, which was not significantly different from the $13,980 cost incurred by the control group (P = .732) (n = 182). The LAI group incurred $3,028 per quarter in medication cost, significantly more than the $1,913 incurred by the control group (P = .003). Hospitalization costs were $7,088 in the experimental group and $6,891 in the control group (P = .943); outpatient costs were $11,888 in the experimental group and $12,067 in the control group (P = .639). LAI risperidone did not result in better outcomes as evaluated by a measure of schizophrenia symptoms or an assessment of health related quality of life and incurred more adverse events.
Patients with unstable schizophrenia were randomized in a practical trial of LAI risperidone. This antipsychotic significantly increased medication costs but did not reduce hospital or total health care cost or improve outcomes and was thus not cost-effective.
ClinicalTrials.gov identifier: NCT00132314.
通过一项多中心临床试验，确定长效注射用利培酮对医疗保健费用的影响。
2006 年至 2009 年，通过 DSM-IV 结构临床访谈确定患有不稳定精神分裂症或分裂情感障碍的退伍军人健康管理局患者（N=369）被随机分为长效利培酮组或医生选择的口服抗精神病药物组。通过行政数据跟踪医疗保健的使用和成本。试验中使用的药物在病例报告表上记录。药物成本基于美国医疗补助计划的单位成本。使用生活质量量表评估经济结果。
随机分配到长效利培酮组（n=187）的参与者每季度的总医疗保健费用为 14916 美元，与对照组（n=182）的 13980 美元的费用无显著差异（P=0.732）。长效利培酮组每季度的药物费用为 3028 美元，明显高于对照组的 1913 美元（P=0.003）。实验组的住院费用为 7088 美元，对照组为 6891 美元（P=0.943）；实验组的门诊费用为 11888 美元，对照组为 12067 美元（P=0.639）。长效利培酮在评估精神分裂症症状的指标或评估健康相关生活质量方面并未产生更好的结果，并且导致更多的不良反应。
患有不稳定精神分裂症的患者在一项长效利培酮的实际试验中被随机分组。这种抗精神病药物显著增加了药物成本，但并未降低医院或总医疗保健成本或改善结果，因此没有成本效益。
ClinicalTrials.gov 标识符：NCT00132314。
