School of Medicine, University of California, Irvine, CA 92668, USA.
J Med Econ. 2013;16(4):522-8. doi: 10.3111/13696998.2013.771641. Epub 2013 Feb 12.
This study compared healthcare resource usage and costs before and after initiating LAI antipsychotics among Medicaid-insured schizophrenia patients.
Schizophrenia patients ≥13 years of age initiating LAI antipsychotics were identified from the Thomson Reuters MarketScan® Research Medicaid database between 7/1/2005 and 6/30/2010. Patients were required to have 6 months of continuous medical/prescription drug coverage prior to LAI initiation (baseline period) and during a variable follow-up period. Annualized healthcare resource usage and costs for the baseline and follow-up periods were determined and compared.
Among 5694 eligible patients, 55% were male and 45% were female, and the majority of the population was between the ages of 18-55 (86%). The study population had low general comorbidity, as assessed by the Charlson Comorbidity Index (CCI). Diabetes (17%) and chronic pulmonary disease (14%) were the most prevalent comorbidities. In comparison to the baseline period, during the follow-up period (mean duration = 25.7 months) the mean number of hospitalizations, all cause (1.52 ± 2.41 vs 0.70 ± 1.61, p < 0.001) and schizophrenia-related (1.21 ± 2.04 vs 0.57 ± 1.41, p < 0.001) declined as well as hospital lengths of stay (all cause: 14.77 ± 28.61 vs 5.75 ± 16.26 days, p < 0.001; schizophrenia-related: 12.39 ± 25.86 vs 4.67 ± 13.54 days, p < 0.001). As a result, annualized hospital payments were much lower (all cause: $16,249 ± $36,404 vs $7380 ± $21,087, p < 0.001; schizophrenia-related: $13,388 ± $31,614 vs $5645 ± $15,767, p < 0.001).
This study attempted to minimize the impact of differences in patient characteristics by having patients serve as their own controls in the before vs after comparison, however one still may not be able to account for all confounders in this non-randomized study population.
For patients with schizophrenia who initiate LAI antipsychotic therapy, there is an improvement in disease management based on fewer hospitalizations for relapses, which is also associated with a marked reduction in healthcare costs.
本研究比较了 Medicaid 保险的精神分裂症患者在开始使用长效抗精神病药物前后的医疗资源使用和成本。
从 Thomson Reuters MarketScan® Research Medicaid 数据库中确定了 2005 年 7 月 1 日至 2010 年 6 月 30 日期间开始使用长效抗精神病药物的≥13 岁的精神分裂症患者。患者在开始使用长效抗精神病药物前（基线期）和在可变随访期内必须有 6 个月的连续医疗/处方药覆盖。确定并比较了基线期和随访期的年度医疗资源使用和成本。
在 5694 名合格患者中，55%为男性，45%为女性，大多数患者年龄在 18-55 岁之间（86%）。研究人群的一般合并症较低，Charlson 合并症指数（CCI）评估为低。糖尿病（17%）和慢性肺部疾病（14%）是最常见的合并症。与基线期相比，在随访期（平均持续时间为 25.7 个月）期间，住院次数、所有原因（1.52±2.41 比 0.70±1.61，p<0.001）和精神分裂症相关（1.21±2.04 比 0.57±1.41，p<0.001）以及住院时间（所有原因：14.77±28.61 比 5.75±16.26 天，p<0.001；精神分裂症相关：12.39±25.86 比 4.67±13.54 天，p<0.001）均有所下降。因此，年度住院费用大大降低（所有原因：16249 美元±36404 美元比 7380 美元±21087 美元，p<0.001；精神分裂症相关：13388 美元±31614 美元比 5645 美元±15767 美元，p<0.001）。
本研究试图通过让患者在前后比较中作为自己的对照来最大程度地减少患者特征差异的影响，但在这个非随机研究人群中，仍然可能无法解释所有混杂因素。
对于开始使用长效抗精神病药物治疗的精神分裂症患者，疾病管理有所改善，复发住院次数减少，这也与医疗保健成本的大幅降低有关。
