Davies L M, Drummond M F
Centre for Health Economics, University of York, Heslington.
Br J Psychiatry. 1993 Jan;162:38-42. doi: 10.1192/bjp.162.1.38.
An analysis was conducted on the basis of available data to assess the economic consequences of clozapine therapy for people with moderate to severe schizophrenia in long-stay institutions or staffed group homes, with a view to providing an estimate of the likely costs and benefits of the drug. Data from a cost-effectiveness study conducted in the US, supplemented by other literature sources, were used to construct a clinical decision tree for likely clinical outcomes for such patients. A panel of UK psychiatrists provided consensus on how these patients would have been managed in the UK. The costs associated with each patient outcome were estimated, and a sensitivity analysis performed to test the assumptions made. For the patients themselves, clozapine would lead to a net gain of 5.87 years of life with no disability or only mild disability. The base case analysis showed that the direct costs of using clozapine were 91 pounds less per annum (or 1333 pounds per lifetime) than for standard neuroleptic therapy, when the effect on all health-care resources was taken into account. In addition, the sensitivity analysis showed that clozapine would be cost-saving or cost-neutral under many different assumptions. A prospective health economic study with clozapine in the management of schizophrenia would be desirable to confirm these results.
基于现有数据进行了一项分析，以评估氯氮平疗法对长期住院机构或有工作人员的集体之家中度至重度精神分裂症患者的经济影响，目的是估计该药物可能的成本和效益。利用在美国进行的一项成本效益研究的数据，并辅以其他文献来源，构建了一个针对此类患者可能临床结果的临床决策树。一组英国精神科医生就是否在英国这样管理这些患者达成了共识。估计了与每个患者结果相关的成本，并进行了敏感性分析以检验所作的假设。对于患者自身而言，氯氮平将使他们获得5.87年无残疾或仅有轻度残疾的生命净收益。基础病例分析表明，考虑到对所有医疗资源的影响，使用氯氮平的直接成本比标准抗精神病药物疗法每年少91英镑（或终生少1333英镑）。此外，敏感性分析表明，在许多不同假设下，氯氮平都将节省成本或成本持平。开展一项关于氯氮平治疗精神分裂症的前瞻性健康经济学研究以证实这些结果将是可取的。
