Potempa Christoph, Rychlik Reinhard
Institute of Empirical Health Economics, Am Ziegelfeld 28, 51399, Burscheid, Germany.
Health Econ Rev. 2018 Nov 23;8(1):30. doi: 10.1186/s13561-018-0215-5.
Examine cost-driving factors of schizophrenia in Germany for patients prior- and post-switch from an oral antipsychotic therapy to aripiprazole-depot and perform a budget impact analysis (BIA) referring to the context of German health care.
A single-armed, retrospective, non-interventional pre-post comparison study with 132 patients to compare the total psychiatric hospitalization rates and the associated costs of both, the treatment with oral antipsychotics and aripiprazole-depot. The BIA was performed to compare both treatment periods with respect to health-related costs. A subsequent univariate sensitivity analysis examined the robustness of the results.
After switching the treatment to aripiprazole-depot, the total psychiatric hospitalization rates for the 6-month treatment period were significantly (p < 0.001) lower (14%) compared to the hospitalization rates when treated with oral antipsychotics (55.1%). 18.2% of the patients reported to be employed, with 29.2% having work incapacities. The mean number of schizophrenia episodes was 2.58 episodes per patient during the oral-antipsychotic treatment compared to 0.41 episodes per patient during the aripiprazole-depot phase (p < 0.001). The treatment with aripiprazole-depot also significantly reduced the mean number of hospitalizations per patient (0.63 to 0.16, p < 0.001) and the mean number of hospitalized days (27.39 to 5.56, p < 0.001) compared to the oral antipsychotic treatment. Additionally a significant reduction of the mean stay in day-clinics and psychiatric institute ambulances (PIAs) was observed (46.13 days to 7.29 days, p < 0.01). Treatment of a patient suffering from schizophrenia with oral antipsychotics produced costs of 9935.38€ (direct costs: 9498.36 €), while aripiprazole-depot generated costs of 4557.56€ (direct costs: 4449.83 €) per patient for a one-year observation period. This resulted in total costs of 6,517,606,265.43€ for the oral antipsychotic treatment and 2,989,756,603.05€ for aripiprazole-depot treatment from the perspective of the German health care system. The results remained robust during sensitivity analysis, with aripiprazole-depot being the more cost-effective strategy.
The results suggest that aripiprazole-depot treatment for schizophrenia patients has major potential in terms of cost savings for the German statutory health insurance.
研究德国精神分裂症患者从口服抗精神病药物治疗转换为阿立哌唑长效针剂治疗前后的成本驱动因素，并结合德国医疗保健背景进行预算影响分析（BIA）。
一项单臂、回顾性、非干预性的前后对照研究，纳入132例患者，比较口服抗精神病药物治疗和阿立哌唑长效针剂治疗的总精神科住院率及相关成本。进行BIA以比较两个治疗阶段的健康相关成本。随后进行单因素敏感性分析以检验结果的稳健性。
转换为阿立哌唑长效针剂治疗后，6个月治疗期的总精神科住院率显著低于口服抗精神病药物治疗时（p < 0.001），降低了14%（口服抗精神病药物治疗时住院率为55.1%）。18.2%的患者报告有工作，29.2%的患者无工作能力。口服抗精神病药物治疗期间，每位患者精神分裂症发作的平均次数为2.58次，而阿立哌唑长效针剂治疗阶段每位患者为0.41次（p < 0.001）。与口服抗精神病药物治疗相比，阿立哌唑长效针剂治疗还显著降低了每位患者的平均住院次数（从0.63次降至0.16次，p < 0.001）和平均住院天数（从27.39天降至5.56天，p < 0.001）。此外，日间诊所和精神病院救护车（PIA）的平均停留时间也显著减少（从46.13天降至7.29天，p < 0.０1）。口服抗精神病药物治疗一名精神分裂症患者的成本为9935.38欧元（直接成本：9498.36欧元），而阿立哌唑长效针剂治疗每位患者一年观察期的成本为4557.56欧元（直接成本：4449.83欧元）。从德国医疗保健系统的角度来看，口服抗精神病药物治疗的总成本为6517606265.43欧元，阿立哌唑长效针剂治疗的总成本为2989756603.05欧元。在敏感性分析中结果仍然稳健，阿立哌唑长效针剂是更具成本效益的策略。
结果表明，阿立哌唑长效针剂治疗精神分裂症患者对德国法定医疗保险而言在成本节约方面具有重大潜力。
