Nakamura Yusuke, Shibata Isao, Mahlich Jörg
Janssen K.K., Tokyo, Japan.
Kawaguchi Clinic, Saitama, Japan.
Neurol Ther. 2019 Dec;8(2):433-447. doi: 10.1007/s40120-019-0147-y. Epub 2019 Aug 10.
The Japanese government's current policy is to encourage hospitals to discharge hospital patients with schizophrenia earlier and provide them with community care. This study aims to analyze clinical and economic outcomes of different discharge strategies in psychiatric hospitals in Japan.
A simulation was conducted to compare patient relapse and hospital revenues for different discharge plans. We constructed a decision tree where each tree consists of a different Markov chain that models hospital revenue for four different discharge plans: discharge of the patient after 1, 2, or 3 months, or 4 months or more. The simulation also included variations in the medical treatment regimen in an outpatient setting as part of the discharge strategy. In particular, we looked at the choice between risperidone long-acting injectable (RLAI) and generic risperidone (RIS GE).
The use of RLAI in an outpatient setting reduced the number of rehospitalizations compared to generic risperidone use under all discharge plans. Different discharge plans were associated with differences in economic outcomes as well. One of the key revenue drivers for the hospital was the continuation of treatment in the outpatient setting after discharge.
The use of RLAI in an outpatient setting could help to prevent rehospitalization, thereby contributing to better community care.
The Rapid Service Fee was funded by Janssen KK.
日本政府目前的政策是鼓励医院更早地让精神分裂症患者出院，并为他们提供社区护理。本研究旨在分析日本精神病医院不同出院策略的临床和经济结果。
进行了一项模拟，以比较不同出院计划下患者的复发情况和医院收入。我们构建了一个决策树，其中每棵树由不同的马尔可夫链组成，该链对四种不同出院计划的医院收入进行建模：患者在1、2或3个月后出院，或4个月及以上出院。模拟还包括作为出院策略一部分的门诊治疗方案的变化。特别是，我们研究了长效注射用利培酮（RLAI）和普通利培酮（RIS GE）之间的选择。
与在所有出院计划下使用普通利培酮相比，在门诊使用RLAI减少了再住院次数。不同的出院计划也与经济结果的差异相关。医院的关键收入驱动因素之一是出院后在门诊继续治疗。
在门诊使用RLAI有助于预防再住院，从而有助于提供更好的社区护理。
快速服务费由杨森株式会社提供。
