Finley P R, Sommer B R, Corbitt J L, Brunson G H, Lum B L
Department of Clinical Pharmacy, University of California at San Francisco 94143-0622, USA.
Psychopharmacol Bull. 1998;34(1):75-81.
Although risperidone seems to be a safe and effective treatment for the management of psychotic symptoms, its acquisition cost is considerably higher than that of conventional antipsychotics, and its precise role in managing psychiatric illnesses has yet to be defined. The purpose of this investigation was to examine the relationship of patient demographic variables to therapeutic outcomes and to analyze the financial impact of risperidone on the treatment of psychotic symptoms. Subjects included in this 2-year, retrospective cohort, intent-to-treat analysis were all patients initiated on risperidone therapy at an inpatient psychiatric treatment facility. Clinical outcomes were assessed from the absolute change in hospitalized days, total number of psychotropic medications prescribed, and historic Clinical Global Impression severity scores. Logistic regression analysis was conducted to analyze the potential relationship to certain demographic variables to therapeutic response. The cost-benefit analysis compared the direct treatment costs incurred by the institution before and after risperidone initiation. Of the 66 patients originally started on risperidone, 57 completed a therapeutic trial. A clinical response was evident in 54 percent of these patients overall. Logistic regression analysis identified previous treatment intolerance and a negative history of substance abuse as predictive of therapeutic success with risperidone (p = .0006 and p = .01, respectively). Hospitalization rates declined by 43 percent among treatment responders and by 1.3 percent among nonresponders resulting in a net annual savings of $147,962. Risperidone may be efficacious in many patients who had previously failed antipsychotic trials. Patients who had been unable to tolerate traditional antipsychotics and those who lacked a documented history of substance abuse were uniquely responsive to risperidone treatment. The significant decline in hospitalized days that was observed among responsive patients seems to indicate that risperidone may be a cost-effective approach to the management of psychotic symptoms.
尽管利培酮似乎是治疗精神病症状的一种安全有效的药物，但其购置成本远高于传统抗精神病药物，而且其在治疗精神疾病的确切作用尚未明确。本研究的目的是检验患者人口统计学变量与治疗结果之间的关系，并分析利培酮对精神病症状治疗的经济影响。本项为期2年的回顾性队列意向性治疗分析纳入的研究对象为在一家住院精神科治疗机构开始接受利培酮治疗的所有患者。通过住院天数的绝对变化、所开具精神药物的总数以及既往临床总体印象严重程度评分来评估临床结果。进行逻辑回归分析以分析某些人口统计学变量与治疗反应之间的潜在关系。成本效益分析比较了该机构在开始使用利培酮之前和之后产生的直接治疗成本。在最初开始使用利培酮的66例患者中，57例完成了一个疗程的治疗。这些患者中总体有54%出现了临床反应。逻辑回归分析确定既往治疗不耐受和药物滥用阴性史可预测利培酮治疗成功（p值分别为0.0006和0.01）。治疗有反应者的住院率下降了43%，无反应者下降了1.3%，每年净节省147,962美元。利培酮可能对许多之前抗精神病药物试验失败的患者有效。无法耐受传统抗精神病药物的患者以及没有药物滥用记录史的患者对利培酮治疗有独特反应。在有反应的患者中观察到的住院天数显著下降似乎表明利培酮可能是一种治疗精神病症状的经济有效的方法。
