Sclar D A, Robison L M, Skaer T L, Galin R S, Legg R F, Nemec N L, Hughes T E, Buesching D P, Morgan M
College of Pharmacy, Washington State University, Pullman, USA.
J Int Med Res. 1995 Nov-Dec;23(6):395-412. doi: 10.1177/030006059502300601.
The present study was designed to compare direct health service expenditures, for the treatment of depression, among patients enrolled in a health maintenance organization, and prescribed one of three selective serotonin reuptake inhibitors, fluoxetine, paroxetine or sertraline. Information regarding depression-related health service use was derived from the computer archive of a network-model health maintenance organization system serving 700,000 beneficiaries. A total of 744 health maintenance organization beneficiaries were found to satisfy the study selection criteria. Multivariate regression analysis was used to determine the incremental influence of selected demographic, clinical, financial and provider characteristics on health service expenditures related to the treatment of depression (ICD-9-CM, or DSM-IV code 296.2) 1 year after the start of antidepressant pharmacotherapy. Multivariate findings indicate that treatment with paroxetine increases average expenditures for physician visits ($31.93; P < or = 0.05), psychiatric visits ($19.33; NS), laboratory tests ($2.35; P < or = 0.05), hospitalizations ($85.33; P < or = 0.05), psychiatric hospitalizations ($82.01; P < or = 0.05), and antidepressant pharmacotherapy ($63.72; P < or = 0.05), for a total per capita increase in health service use of $284.68 (P < or = 0.05), compared with treatment with fluoxetine. Sertraline treatment increases average expenditures for physician visits ($21.74; P < or = 0.05), psychiatric visits ($56.79; P < or = 0.05), laboratory tests ($1.21; P < or = 0.05), hospitalizations ($70.59; P < or = 0.05), psychiatric hospitalizations ($95.75; P < or = 0.05), and antidepressant pharmacotherapy ($69.85; P < or = 0.05), for a total per capita increase in health service use of $315.96 (P < or = 0.05), compared with treatment with fluoxetine. Economic comparisons between paroxetine and sertraline did not demonstrate any significant differences in expenditures for the health services examined.
本研究旨在比较参加健康维护组织并被开具三种选择性5-羟色胺再摄取抑制剂（氟西汀、帕罗西汀或舍曲林）之一的抑郁症患者的直接医疗服务支出。有关抑郁症相关医疗服务使用的信息来自一个为70万受益者服务的网络模式健康维护组织系统的计算机存档。总共发现744名健康维护组织受益者符合研究选择标准。多变量回归分析用于确定在抗抑郁药物治疗开始1年后，所选人口统计学、临床、财务和医疗服务提供者特征对与抑郁症治疗（国际疾病分类第九版临床修订本，或精神疾病诊断与统计手册第四版代码296.2）相关的医疗服务支出的增量影响。多变量研究结果表明，与氟西汀治疗相比，帕罗西汀治疗使门诊就诊平均支出增加（31.93美元；P≤0.05）、精神科就诊增加（19.33美元；无统计学意义）、实验室检查增加（2.35美元；P≤0.05）、住院增加（85.33美元；P≤0.05）、精神科住院增加（82.01美元；P≤0.05）以及抗抑郁药物治疗增加（63.72美元；P≤0.05），人均医疗服务使用总增加额为284.68美元（P≤0.05）。与氟西汀治疗相比，舍曲林治疗使门诊就诊平均支出增加（21.74美元；P≤0.05）、精神科就诊增加（56.79美元；P≤0.05）、实验室检查增加（1.21美元；P≤0.05）、住院增加（70.59美元；P≤0.05）、精神科住院增加（95.75美元；P≤0.05）以及抗抑郁药物治疗增加（69.85美元；P≤0.05），人均医疗服务使用总增加额为315.96美元（P≤0.05）。帕罗西汀和舍曲林之间的经济比较未显示在所检查的医疗服务支出方面有任何显著差异。
