Croghan T W, Lair T J, Engelhart L, Crown W E, Copley-Merriman C, Melfi C A, Obenchain R L, Buesching D P
Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA.
Psychiatr Serv. 1997 Nov;48(11):1420-6. doi: 10.1176/ps.48.11.1420.
Four groups of patients receiving different antidepressant drugs in a primary care setting were compared in terms of duration of antidepressant therapy and health and mental health care utilization and costs.
A retrospective analysis of the medical and pharmacy claims of an employed population and their families was conducted. A total of 1,242 patients with a diagnosis of depression were included in the analyses. The four antidepressant cohorts were fluoxetine (N = 799), trazodone (N = 89), the tricyclics amitriptyline and imipramine (N = 104), and the secondary amine tricyclics desipramine and nortriptyline (N = 250). The primary outcome measures were total health care charges, total charges for mental health services, and the pattern of antidepressant use. Secondary measures included charges for outpatient care and pharmacy and the number of outpatient visits. Data analysis involved use of two-stage multivariate regression modeling known as sample selection models.
Patients taking fluoxetine achieved higher rates of continuous use for at least six months compared with those taking the other drugs. After selection bias due to observed and unobserved characteristics and other confounding variables was adjusted for, no significant differences were found between drug cohorts in total medical charges.
Improvements in the process of care at no apparent increase in total charges appear possible through appropriate medication therapy.
比较在基层医疗环境中接受不同抗抑郁药物治疗的四组患者在抗抑郁治疗持续时间、医疗保健和心理健康服务利用情况以及费用方面的差异。
对在职人员及其家属的医疗和药房报销申请进行回顾性分析。共有1242例诊断为抑郁症的患者纳入分析。四组抗抑郁药物队列分别为氟西汀（N = 799）、曲唑酮（N = 89）、三环类药物阿米替林和丙咪嗪（N = 104）以及仲胺三环类药物地昔帕明和去甲替林（N = 250）。主要结局指标为总医疗费用、心理健康服务总费用以及抗抑郁药物使用模式。次要指标包括门诊护理和药房费用以及门诊就诊次数。数据分析采用两阶段多变量回归建模，即样本选择模型。
与服用其他药物的患者相比，服用氟西汀的患者至少连续使用六个月的比例更高。在对观察到和未观察到的特征以及其他混杂变量导致的选择偏倚进行调整后，各药物队列在总医疗费用方面未发现显著差异。
通过适当的药物治疗，在不明显增加总费用的情况下改善护理过程似乎是可行的。
