Robertson Lesley J, Miot Jacqui K, van Rensburg Bernard Janse
Department of Psychiatry, School of Clinical Medicine, University of the Witwatersrand, South Africa.
Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, South Africa.
S Afr J Psychiatr. 2017 Jul 17;23:1057. doi: 10.4102/sajpsychiatry.v23i0.1057. eCollection 2017.
With the revision of the National Essential Medicines List in South Africa, quetiapine is only available at the discretion of individual institutions in the public health sector. However, quetiapine is effective in managing all aspects of bipolar disorder, including preventative treatment of depressive episodes, and may be a cost-effective option in severe illness.
To present the first retrospective review of quetiapine use in a peri-urban health district of South Africa, describing the patient profile, clinical response and prescribing patterns.
The clinical files of all patients in Sedibeng District who received quetiapine over a defined 3-year period (2011-2013) were reviewed. A positive clinical response was defined as both symptomatic and functional improvement. Demographic and clinical characteristics of responders were compared with that of non-responders. Pre- and post-quetiapine scripts of the responders were audited and costed.
Patients who received quetiapine ( = 40) had chronic disabling illness, often with multiple medication trials and hospitalisations prior to quetiapine use. Bipolar II disorder (followed by bipolar I disorder) was the most common primary psychiatric diagnosis documented. Other than improvement in functioning ( < 0.0001), responders differed significantly from non-responders in terms of a higher level of polypharmacy and a significant reduction in median number of medications from pre- to post-quetiapine ( = 0.0057).
Quetiapine use was associated with a highly significant improvement in functioning; however, it came at a 52% increase in medicine cost. Pre-quetiapine treatments, though, did not achieve an optimal level of functioning, and overall costs may be reduced by more rational prescribing habits.
随着南非国家基本药物目录的修订，喹硫平仅可由公共卫生部门的各机构自行决定是否提供。然而，喹硫平在双相情感障碍的各个方面管理中均有效，包括抑郁发作的预防性治疗，并且在重症疾病中可能是一种具有成本效益的选择。
对南非一个城郊卫生区使用喹硫平的情况进行首次回顾性研究，描述患者概况、临床反应和处方模式。
回顾了塞迪本地区在特定3年期间（2011 - 2013年）接受喹硫平治疗的所有患者的临床档案。积极的临床反应定义为症状和功能均有改善。将有反应者的人口统计学和临床特征与无反应者进行比较。对有反应者使用喹硫平前后的处方进行审核并计算成本。
接受喹硫平治疗的患者（n = 40）患有慢性致残性疾病，在使用喹硫平之前通常进行过多次药物试验和住院治疗。记录的最常见的原发性精神疾病诊断是双相II型障碍（其次是双相I型障碍）。除功能改善外（P < 0.0001），有反应者与无反应者在多药联用水平较高以及使用喹硫平前后药物中位数显著减少方面（P = 0.0057）存在显著差异。
使用喹硫平与功能的高度显著改善相关；然而，药品成本增加了52%。不过，喹硫平治疗前的治疗并未达到最佳功能水平，通过更合理的处方习惯可能会降低总体成本。
