泰国精神分裂症患者从非典型抗精神病药物转换为典型抗精神病药物后的住院情况及费用

Hospitalization and cost after switching from atypical to typical antipsychotics in schizophrenia patients in Thailand.

作者信息

Boonlue Tuanthon, Subongkot Suphat, Dilokthornsakul Piyameth, Kongsakon Ronnachai, Pattanaprateep Oraluck, Suanchang Orabhorn, Chaiyakunapruk Nathorn

机构信息

Clinical Pharmacy Division, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand; The College of Pharmacotherapy of Thailand, Nonthaburi, Thailand.

Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; Center for Pharmaceutical Outcomes Research, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.

出版信息

Clinicoecon Outcomes Res. 2016 Apr 29;8:127-36. doi: 10.2147/CEOR.S97300. eCollection 2016.

DOI:10.2147/CEOR.S97300

PMID:27199568

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4857758/

Abstract

BACKGROUND

Several clinical practice guidelines suggest using atypical over typical antipsychotics in patients diagnosed with schizophrenia. Nevertheless, cost-containment policy urged restricting usage of atypical antipsychotics and switching from atypical to typical antipsychotics.

OBJECTIVE

This study aimed to evaluate clinical and economic impacts of switching from atypical to typical antipsychotics in schizophrenia patients in Thailand.

METHODS

From October 2010 through September 2013, a retrospective cohort study was performed utilizing electronic database of two tertiary hospitals. Schizophrenia patients aged 18 years or older and being treated with atypical antipsychotics were included. Patients were classified as atypical antipsychotic switching group if they switched to typical antipsychotics after 180 days of continual atypical antipsychotics therapy. Outcomes were schizophrenia-related hospitalization and total health care cost. Logistic and Poisson regression were used to evaluate the risk of hospitalization, and generalized linear model with gamma distribution was used to determine the health care cost. All analyses were adjusted by employing propensity score and multivariable analyses. All cost estimates were adjusted according to 2013 consumer price index and converted to US$ at an exchange rate of 32.85 Thai bahts/US$.

RESULTS

A total of 2,354 patients were included. Of them, 166 (7.1%) patients switched to typical antipsychotics. The adjusted odds ratio for schizophrenia-related hospitalization in atypical antipsychotic switching group was 1.87 (95% confidence interval [CI] 1.23-2.83). The adjusted incidence rate ratio was 2.44 (95% CI 1.57-3.79) for schizophrenia-related hospitalizations. The average total health care cost was lower in patients with antipsychotic switching (-$64; 95% CI -$459 to $332).

CONCLUSION

Switching from atypical to typical antipsychotics is associated with an increased risk of schizophrenia-related hospitalization. Nonetheless, association with average total health care cost was not observed. These findings can be of use as a part of evidence in executing prospective cost-containment policy.

摘要

背景

多项临床实践指南建议，对于被诊断为精神分裂症的患者，使用非典型抗精神病药物而非典型抗精神病药物。然而，成本控制政策敦促限制非典型抗精神病药物的使用，并从非典型抗精神病药物转换为典型抗精神病药物。

目的

本研究旨在评估泰国精神分裂症患者从非典型抗精神病药物转换为典型抗精神病药物的临床和经济影响。

方法

从2010年10月至2013年9月，利用两家三级医院的电子数据库进行了一项回顾性队列研究。纳入年龄在18岁及以上且正在接受非典型抗精神病药物治疗的精神分裂症患者。如果患者在连续使用非典型抗精神病药物治疗180天后转换为典型抗精神病药物，则被分类为非典型抗精神病药物转换组。结局指标为与精神分裂症相关的住院治疗和总医疗费用。采用逻辑回归和泊松回归评估住院风险，并使用具有伽马分布的广义线性模型确定医疗费用。所有分析均通过倾向评分和多变量分析进行调整。所有成本估计均根据2013年消费者价格指数进行调整，并以32.85泰铢/美元的汇率换算为美元。

结果

共纳入2354例患者。其中，166例（7.1%）患者转换为典型抗精神病药物。非典型抗精神病药物转换组与精神分裂症相关住院治疗的调整后优势比为1.87（95%置信区间[CI]1.23 - 2.83）。与精神分裂症相关住院治疗的调整后发病率比为2.44（95%CI 1.57 - 3.79）。抗精神病药物转换患者的平均总医疗费用较低（-64美元；95%CI -459至332美元）。