Reid W H
Texas Department of Mental Health and Mental Retardation, Austin.
J Clin Psychiatry. 1994 Sep;55 Suppl B:166-8.
Cost-effective means different, sometimes competing things to different observers. In addition to well-known clinical benefits, large payors such as state governments think clozapine and similarly effective antipsychotic medications will yield immediate dollar savings. They do not consider the need to shift existing resources to community follow-up, the time required to phase out hospital units, and the backlogs of new patients. In today's financial climate, legislators and other elected officials are reluctant to invest in expensive medicines and then wait for long-term savings. We must convince those who hold the purse strings that acceptable antipsychotic drugs will be expensive for at least several years to come, until more new and generic drugs appear. We must tell them firmly that our patients, doctors, and mental health systems cannot afford to rely on older medications, even though they seem inexpensive. The drug cost "thermostat" should be reset so that payors and budget reviewers realize that safe and adequate antipsychotic medications often cost $5 to $25 a day. If new dollars are not available, existing budgets may have to be restructured. For most patients, anything else is substandard.
性价比对于不同的观察者而言有着不同的含义，有时甚至相互矛盾。除了众所周知的临床益处外，像州政府这样的大型医保支付方认为氯氮平及其他类似的高效抗精神病药物能立即节省资金。他们没有考虑到将现有资源转移到社区随访的必要性、逐步淘汰医院病房所需的时间以及新患者的积压情况。在如今的经济形势下，立法者和其他当选官员不愿投资于昂贵的药物，然后等待长期的节省。我们必须让那些掌控资金的人相信，在未来至少几年内，可接受的抗精神病药物都会很昂贵，直到更多的新药和仿制药出现。我们必须坚定地告诉他们，我们的患者、医生和心理健康系统都无法依赖旧药物，尽管它们看起来很便宜。药物成本的“恒温器”应该重新设定，以便医保支付方和预算审核者意识到，安全且足够的抗精神病药物通常每天花费5至25美元。如果没有新的资金，现有的预算可能就得重新调整。对大多数患者来说，其他任何情况都是不合格的。
