Ozminkowski R J, Hylan T R, Melfi C A, Meneades L M, Crown W H, Croghan T W, Robinson R L
The MEDSTAT Group, Inc., Ann Arbor, Michigan, USA.
Clin Ther. 1998 Jul-Aug;20(4):780-96. doi: 10.1016/s0149-2918(98)80141-0.
Administration of selective serotonin reuptake inhibitors (SSRIs) may increase plasma concentrations of concomitant medications that are also metabolized by the cytochrome P-450 system (CYP-450), in particular by the 2D6 and 3A4 isoenzymes. This may lead to side effects or other clinical events that might be expected to incur higher health-care expenditures. The purpose of this study was to assess whether there was a difference in expenditures during the first 90 days of SSRI therapy with paroxetine or sertraline versus fluoxetine in patients who were also receiving a stable dosage of a nonpsychiatric drug also metabolized by the CYP-450 2D6 or 3A4 isoenzyme systems. A sample of 2445 patients who initiated therapy with an SSRI while receiving a stable dosage of a nonpsychiatric drug was obtained from a private insurance claims database. Multivariate regression techniques were used to estimate total health-care expenditures in the first 90 days after receiving a prescription for an SSRI. After adjusting for nonrandom SSRI prescription patterns and controlling for observable and unobservable characteristics that might correlate with SSRI selection, total health-care expenditures were 95% higher for patients initiating SSRI therapy with sertraline or paroxetine compared with fluoxetine. Results suggest that there are cost differences between SSRIs during concomitant therapy with drugs also metabolized by the CYP-450 system. To determine whether there are additional differences in expenditures across SSRIs, future research should focus on (1) simultaneous initiation of SSRI therapy and a nonpsychiatric drug also metabolized by the CYP-450 enzyme system, and (2) addition of nonpsychiatric drug therapy to stable SSRI therapy. Relationships between additional expenditures, drug interactions, and clinical outcomes should also be assessed directly using medical records and patient interview data that are not available in claims-based files.
选择性5-羟色胺再摄取抑制剂（SSRI）的使用可能会增加同时服用的其他药物的血浆浓度，这些药物同样经细胞色素P-450系统（CYP-450）代谢，尤其是经2D6和3A4同工酶代谢。这可能会导致副作用或其他临床事件，进而可能产生更高的医疗保健费用。本研究的目的是评估在同时接受稳定剂量的、同样经CYP-450 2D6或3A4同工酶系统代谢的非精神科药物治疗的患者中，使用帕罗西汀或舍曲林进行SSRI治疗的前90天与使用氟西汀进行SSRI治疗的前90天，其费用是否存在差异。从一个私人保险理赔数据库中选取了2445名在接受稳定剂量非精神科药物治疗的同时开始使用SSRI治疗的患者作为样本。采用多变量回归技术来估算在收到SSRI处方后的前90天内的总医疗保健费用。在调整了非随机的SSRI处方模式，并控制了可能与SSRI选择相关的可观察和不可观察特征后，与使用氟西汀的患者相比，使用舍曲林或帕罗西汀开始SSRI治疗的患者的总医疗保健费用高出95%。结果表明，在与同样经CYP-450系统代谢的药物联合治疗期间，不同SSRI之间存在费用差异。为了确定不同SSRI之间在费用方面是否存在其他差异，未来的研究应关注：（1）同时开始SSRI治疗和同样经CYP-450酶系统代谢的非精神科药物治疗；（2）在稳定的SSRI治疗基础上增加非精神科药物治疗。还应直接使用基于理赔文件中没有的病历和患者访谈数据，来评估额外费用、药物相互作用和临床结果之间的关系。
