Melton S T, Kirkwood C K, Farrar T W, Brink D D, Carroll N V
Department of Pharmacy and Pharmaceutics, School of Pharmacy, Virginia Commonwealth University, Richmond 23298-0533, USA.
Psychopharmacol Bull. 1997;33(1):93-100.
In this pilot study, we compared the economic impact of paroxetine and imipramine treatment of depressed outpatients from a university teaching hospital and a community mental health center. A 12-month retrospective chart review of patients was performed. Clinical outcomes including clinic usage, death, relapse, function, adverse effects, psychiatrist visits, and drug costs were evaluated. We analyzed drug costs, psychiatrist costs, and total direct costs using the Mann-Whitney U Test. The incidence of clinic usage, death, function, adverse effects, and psychiatrist visits was similar in patients treated with paroxetine (n = 12) and imipramine (n = 13). Two patients in the imipramine group were hospitalized once for a total of 5 days compared with none in the paroxetine group. Paroxetine drug costs were significantly higher than imipramine drug costs. Direct total costs (i.e., drug, psychiatrist visits, blood levels, and hospitalization costs) did not differ significantly between the groups based on actual drug usage (paroxetine: median $1,432.50 per patient per year; imipramine: median $1,425.81 per patient per year). Although the median direct total cost per patient per year for patients who received 12 months of therapy was lower in the paroxetine group ($1,479.90, n = 8) than the imipramine group ($1,503.61, n = 8), the difference was not significant. Our cost minimization analysis revealed no significant difference in the total cost between the two groups. However, the major cost in the paroxetine group was drug cost, whereas the major cost in the imipramine group was hospitalizations. Future large prospective trials are needed to validate these findings.
在这项初步研究中，我们比较了帕罗西汀和丙咪嗪治疗来自一所大学教学医院和一个社区心理健康中心的门诊抑郁症患者的经济影响。对患者进行了为期12个月的回顾性病历审查。评估了临床结局，包括门诊使用情况、死亡、复发、功能、不良反应、精神科医生就诊次数和药物成本。我们使用曼-惠特尼U检验分析了药物成本、精神科医生成本和总直接成本。接受帕罗西汀治疗的患者（n = 12）和接受丙咪嗪治疗的患者（n = 13）在门诊使用情况、死亡、功能、不良反应和精神科医生就诊次数方面的发生率相似。丙咪嗪组有两名患者曾住院一次，共5天，而帕罗西汀组无此情况。帕罗西汀的药物成本显著高于丙咪嗪的药物成本。根据实际药物使用情况，两组之间的直接总成本（即药物、精神科医生就诊、血药浓度和住院成本）没有显著差异（帕罗西汀：每位患者每年中位数为 $1,432.50；丙咪嗪：每位患者每年中位数为 $1,425.81）。尽管接受12个月治疗的患者中，帕罗西汀组每位患者每年的直接总成本中位数（$1,479.90，n = 8）低于丙咪嗪组（$1,503.61，n = 8），但差异不显著。我们的成本最小化分析显示两组之间的总成本没有显著差异。然而，帕罗西汀组的主要成本是药物成本，而丙咪嗪组的主要成本是住院费用。未来需要进行大规模的前瞻性试验来验证这些发现。
