Noordraven Ernst L, Wierdsma André I, Blanken Peter, Bloemendaal Anthony F T, Mulder Cornelis L
Dual Diagnosis Center (CDP) Palier, Parnassia Psychiatric Institute, 2552 KS, The Hague, The Netherlands.
Department of Psychiatry, Erasmus University Medical Center, Epidemiological and Social Psychiatric Research Institute, 3015 CE, Rotterdam, The Netherlands.
BMC Res Notes. 2018 Sep 10;11(1):655. doi: 10.1186/s13104-018-3747-1.
Offering a financial incentive ('Money for Medication') is effective in improving adherence to treatment with depot antipsychotic medications. We investigated the cost-effectiveness in terms of medical costs and judicial expenses of using financial incentives to improve adherence. The effects of financial incentives on depot medication adherence were evaluated in a randomised controlled trial. Patients in the intervention group received €30 a month over 12 months if antipsychotic depot medication was accepted. The control group received mental health care as usual. For 133 patients outcomes were calculated based on self-reported service use and delinquent behaviour and expressed as standard unit costs to value resource use.
The financial incentive resulted in higher average costs related to mental health care (€449.6 versus €355.7). and lower medical costs related to other healthcare services (€52.0 versus €78.4). Relevant differences in social costs related to delinquent behaviour were not found. Although wide confidence intervals indicate uncertainty, incremental cost-effectiveness ratio's (ICER) indicate that it costs €2080 for achieving a 20% increase in adherence or €3332 for achieving over 80% adherence. In sum, offering money as financial incentive for increasing compliance did not lead to an overall cost reduction as compared to care as usual. Trial registration NTR2350, 01 June 2010.
提供经济激励（“药物换金钱”）可有效提高长效抗精神病药物治疗的依从性。我们从医疗费用和司法费用方面调查了使用经济激励措施提高依从性的成本效益。在一项随机对照试验中评估了经济激励对长效药物依从性的影响。如果干预组患者接受长效抗精神病药物治疗，他们在12个月内每月可获得30欧元。对照组接受常规精神卫生保健。对于133名患者，根据自我报告的服务使用情况和违法行为计算结果，并以标准单位成本表示资源使用价值。
经济激励导致与精神卫生保健相关的平均成本更高（449.6欧元对355.7欧元），而与其他医疗服务相关的医疗成本更低（52.0欧元对78.4欧元）。未发现与违法行为相关的社会成本存在显著差异。尽管宽泛的置信区间表明存在不确定性，但增量成本效益比（ICER）表明，依从性提高20%的成本为2080欧元，依从性超过80%的成本为3332欧元。总之，与常规护理相比，提供金钱作为增加依从性的经济激励措施并未导致总体成本降低。试验注册号NTR2350，2010年6月1日。
