Meltzer H Y, Cola P, Way L, Thompson P A, Bastani B, Davies M A, Snitz B
Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, OH.
Am J Psychiatry. 1993 Nov;150(11):1630-8. doi: 10.1176/ajp.150.11.1630.
The goal of this study was to determine whether clozapine is a cost-effective treatment for treatment-resistant schizophrenia.
Data were collected on 96 treatment-resistant patients with schizophrenia for 2 years before they entered a clozapine treatment study and for at least 2 years after they entered the study. Information about the cost of inpatient and outpatient treatment, housing costs, other costs, and family burden through direct interview or questionnaire of these patients and their families were available for 47 of the 96 patients. Data on lost income and Social Security disability insurance were also obtained. Outcome measures included psychopathology, quality of life, global functioning, work function, and rehospitalization.
The cost of treatment was significantly decreased in the patients who continued clozapine treatment for at least 2 years. This was primarily due to a dramatic decrease in the frequency and cost of rehospitalization. Costs were nonsignificantly lower in patients who dropped out of treatment. The estimated total 2-year cost for the 59 patients who continued clozapine treatment, the 34 patients who dropped out, and the three who interrupted treatment decreased from $7,390,206 to $5,719,463, a savings of $8,702/year per patient. There was a decrease in total costs of $22,936/year for the 37 patients who continued clozapine treatment for whom cost data were available. There were no significant changes in lost income or Social Security disability insurance payments in either group. Clozapine produced a marked improvement in Brief Psychiatric Rating Scale total scores as well as positive negative symptom scores, Global Assessment Scale scores, Quality of Life Scale scores, work functioning, capacity for independent living, and rehospitalization rates.
Clozapine is a cost-effective treatment for treatment-resistant schizophrenic patients. Cost savings result almost exclusively from the reduced cost of hospitalization.
本研究的目的是确定氯氮平是否是治疗难治性精神分裂症的一种具有成本效益的治疗方法。
收集了96例难治性精神分裂症患者在进入氯氮平治疗研究前2年以及进入研究后至少2年的数据。通过对这些患者及其家属进行直接访谈或问卷调查，获得了96例患者中47例的住院和门诊治疗费用、住房费用、其他费用以及家庭负担信息。还获得了收入损失和社会保障残疾保险的数据。结果指标包括精神病理学、生活质量、整体功能、工作功能和再住院情况。
持续接受氯氮平治疗至少2年的患者治疗费用显著降低。这主要是由于再住院频率和费用的大幅下降。退出治疗的患者费用略有降低但无统计学意义。继续接受氯氮平治疗的59例患者、退出治疗的34例患者和中断治疗的3例患者估计的2年总费用从7390206美元降至5719463美元，每位患者每年节省8702美元。对于有费用数据的继续接受氯氮平治疗的37例患者，每年总成本降低22936美元。两组患者的收入损失或社会保障残疾保险支付均无显著变化。氯氮平在简明精神病评定量表总分以及阳性阴性症状评分、总体评定量表评分、生活质量量表评分、工作功能、独立生活能力和再住院率方面均有显著改善。
氯氮平是治疗难治性精神分裂症患者的一种具有成本效益的治疗方法。成本节约几乎完全来自住院费用的降低。
