Nightengale B S, Crumly J M, Liao J, Lawrence B J, Jacobs E W
Applied Health Outcomes, Inc., Palm Harbor, FL 34684, USA.
Psychopharmacol Bull. 1998;34(3):373-82.
Clinical trials reveal that the newer atypical antipsychotic agents are more effective and have fewer side effects than traditional agents. However, these newer agents have a higher acquisition cost than traditional agents. This study assessed the differential impact of risperidone and traditional agents on the total schizophrenia-related cost of care for Medicaid patients suffering from schizophrenia. This was a retrospective longitudinal pretest-posttest analysis of Medicaid claims data covering January 1992 to August 1996. Continuously eligible patients (n = 150) with a documented diagnosis of schizophrenia were evaluated. Medical claims were analyzed for patients treated with traditional antipsychotics for at least 12 months and then switched to risperidone and followed for at least 12 months. Patients who failed on at least one traditional agent and who remained on other traditional agents throughout the study timeframe served as a control group. Monthly costs per patient were estimated using mixed model linear regression with age and gender serving as covariates. The total monthly costs per patient for the risperidone and traditional cohorts were similar ($1,050.52 and $946.24, respectively; p = .5438) during the pretest phase of the study. For patients treated with risperidone, drug costs were $177.35 higher (CL0.95 +/- $7.64; p = .0001) per patient per month in the posttest period compared with the pretest period. However inpatient hospital costs were $312.04 lower (CL0.95 +/- $146.76; p = .001) per patient per month in the posttest period compared with the pretest period. In addition, physician costs were $9.55 lower (CL0.95 +/- $5.31; p = .0004) per patient per month in the posttest period. The difference from the pretest to posttest period for outpatient mental health clinic costs was statistically similar. For those in the risperidone cohort, total estimated costs decreased by $204.87 per patient per month during treatment with risperidone (CL0.95 +/- $161.01; p = .0127). Over the same time-frame, total costs increased $160.68 per patient per month (CL0.95 +/- $196.04; n.s.; p = .1082) in the control cohort. While the mean monthly drug cost was significantly higher during treatment with risperidone, this increase was offset by cost reductions elsewhere in the system.
临床试验表明，新型非典型抗精神病药物比传统药物更有效且副作用更少。然而，这些新型药物的购置成本高于传统药物。本研究评估了利培酮与传统药物对患有精神分裂症的医疗补助患者精神分裂症相关护理总费用的不同影响。这是一项对1992年1月至1996年8月医疗补助索赔数据进行的回顾性纵向前后测分析。对150名有精神分裂症确诊记录的持续符合条件的患者进行了评估。分析了接受传统抗精神病药物治疗至少12个月然后换用利培酮并随访至少12个月的患者的医疗索赔。在整个研究时间段内，至少对一种传统药物治疗无效且一直使用其他传统药物的患者作为对照组。使用以年龄和性别作为协变量的混合模型线性回归估计每位患者的每月费用。在研究的前测阶段，利培酮组和传统药物组每位患者的每月总费用相似（分别为1050.52美元和946.24美元；p = 0.5438）。对于接受利培酮治疗的患者，在后测期间，每位患者每月的药物费用比前测期间高出177.35美元（CL0.95 +/- 7.64美元；p = 0.0001）。然而，在后测期间，每位患者每月的住院费用比前测期间低312.04美元（CL0.95 +/- 146.76美元；p = 0.001）。此外，在后测期间，每位患者每月的医生费用低9.55美元（CL0.95 +/- 5.31美元；p = 0.0004）。门诊心理健康诊所费用从前测到后测期间的差异在统计学上相似。对于利培酮组的患者，在使用利培酮治疗期间，估计每位患者每月的总费用减少了204.87美元（CL0.95 +/- 161.01美元；p = 0.0127）。在同一时间范围内，对照组每位患者每月的总费用增加了160.68美元（CL0.95 +/- 196.04美元；无统计学意义；p = 0.1082）。虽然在使用利培酮治疗期间平均每月药物费用显著更高，但这一增加被系统其他方面的费用降低所抵消。
