Martin P
AMC Research Group, Paris.
Encephale. 1997 Jan;23 Spec No 1:49-54.
The implementation of spending control policies to combat rising healthcare costs and public health department deficits in the industrialised countries poses the problem of how to maintain high standards of treatment and ensure quality of life for patients. Only a proper medico-economic evaluation of the various therapeutic strategies available will allow the two sides of this equation to be reconciled; one wonders in fact whether these two sides are indeed contradictory. This is particularly true as regards the treatment of mental illnesses. Because of their chronic status, together with inherent problems of diagnosis and management, bipolar disorders appear at first sight to present a marked impact in economic terms, and are thus highly problematic for health authorities. Budgetary control is far more complex than simple management of scarce resources, since the least expensive therapies are not necessarily the most cost-effective. Nevertheless, data allowing accurate assessment of the costs related to these disorders are rare or non-existent. Furthermore, the impact of a given treatment for bipolar disorders on the quality of life of the patient may have a direct economic bearing if one takes account of additional drug consumption and further social deficit resulting from unsuccessful therapy, as well as of social and family problems related to this type of disorder.
在工业化国家实施支出控制政策以应对不断上涨的医疗成本和公共卫生部门赤字,引发了如何维持高标准治疗并确保患者生活质量的问题。只有对现有的各种治疗策略进行恰当的医学经济学评估,才能使这个问题的两个方面达成和解;实际上有人怀疑这两个方面是否真的相互矛盾。在精神疾病的治疗方面尤其如此。由于双相情感障碍的慢性状态,再加上诊断和管理方面固有的问题,乍一看,双相情感障碍在经济方面似乎有显著影响,因此对卫生当局来说是个大难题。预算控制远比简单管理稀缺资源复杂得多,因为最便宜的疗法不一定是最具成本效益的。然而,能够准确评估与这些疾病相关成本的数据很少或根本不存在。此外,如果考虑到治疗失败导致的额外药物消费、进一步的社会赤字,以及与这类疾病相关的社会和家庭问题,那么针对双相情感障碍的特定治疗对患者生活质量的影响可能会产生直接的经济影响。