COST OF RELAPSE IN SCHIZOPHRENIA
COST OF RELAPSE IN SCHIZOPHRENIA
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DOI：
10.1093/schbul/21.3.419
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发表时间：
1995-01-01
影响因子：
6.6
通讯作者：
OLFSON, M
中科院分区：
文献类型：
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作者：
WEIDEN, PJ;OLFSON, M
为了估算全国每年多发性精神分裂症门诊患者的再住院费用，并确定因药物疗效丧失和用药不依从而造成的相对成本负担，我们估算了美国每年出院返回门诊治疗的对安定药有反应的多发性精神分裂症住院患者的数量。确定了未来有复发和再住院风险的队列。回顾了关于精神分裂症患者接受抗精神病药物维持治疗的预期复发率的研究文献；特别是，估计了服用最佳剂量长效抗精神病药（最佳抗精神病药剂量）的依从性患者在最佳用药条件下和停止用药（不依从用药）的次优条件下的每月复发率。利用文献中确定的不依从率，可以估计该队列的“现实世界”再住院率，以及因药物疗效丧失和药物不依从而产生的相对负担。最后，住院和再住院指数的成本估算是根据国家住院精神卫生保健支出数据得出的。服用维持性抗精神病药物的患者的每月复发率估计为 3.5%，而停止用药的患者的每月复发率为 11.0%。社区环境中的出院后不依从率估计为每月 7.6%。这些估计值被输入生存分析模型，以确定该队列的现实世界复发率。 1986 年，美国估计有 257,446 名多次发作（大于或等于两次住院）的精神分裂症患者从短期住院（小于或等于 90 天）住院病房出院。该队列指数住院的估计总基线住院费用为 23 亿美元（1993 年美元）。出院后 2 年内，再入院的总费用接近 20 亿美元。抗精神病药疗效丧失约占再住院费用的 60%，抗精神病药不依从性约占 40%。出院后第一年因疗效丧失而造成的经济负担相对较高，而第二年因不遵守规定而造成的经济负担较高。由于药物疗效的丧失和用药不依从性对复发产生协同作用，因此通过将更好的精神分裂症药物治疗与更有效的药物不依从性管理策略结合起来，可以实现大量住院费用的节省。
To estimate the national annual cost of rehospitalization for multiple-episode schizophrenia outpatients, and to determine the relative cost burden from loss of medication efficacy and from medication noncompliance, the yearly number of neuroleptic-responsive multiple-episode schizophrenia inpatients in the United States who are discharged back to outpatient treatment was estimated. The cohort at risk for future relapse and rehospitalization was determined. The research literature on the expected rates of relapse for schizophrenia patients on maintenance antipsychotic medication was reviewed; in particular, monthly relapse rates under the optimal medication conditions of compliant patients taking optimal doses of a depot neuroleptic (optimal neuroleptic dose) and under the less optimal conditions of patients stopping medication (medication noncompliant) was estimated. Using established noncompliance rates from the literature, it became possible to estimate a ''real world'' rehospitalization rate for this cohort, as well as the relative burden accruing from loss of medication efficacy and from medication noncompliance. Finally, cost estimates for index hospitalizations and rehospitalizations were derived from data on national expenditures for inpatient mental health care. The monthly relapse rates are estimated to be 3.5 percent per month for patients on maintenance neuroleptics and 11.0 percent per month for patients who have discontinued their medication. Postdischarge noncompliance rates in community settings are estimated to be 7.6 percent per month. These estimates were entered into a survival analysis model to determine the real world relapse rate of this cohort. An estimated 257,446 multiple-episode (greater than or equal to two hospitalizations) schizophrenia patients were discharged from short-stay (less than or equal to 90 days) inpatient units in the United States during 1986. The estimated aggregate baseline inpatient cost for the index hospitalizations of this cohort was $2.3 billion (1993 dollars). Within 2 years after discharge, the aggregate cost of readmission approached $2 billion. Loss of neuroleptic efficacy accounted for roughly 60 percent of the rehospitalization costs and neuroleptic noncompliance for roughly 40 percent. The economic burden due to loss of efficacy is relatively higher during the first postdischarge year, whereas the burden from noncompliance is higher in the second year. Because loss of medication efficacy and medication noncompliance act synergistically on relapse, substantial inpatient cost savings can be realized by linking better pharmacologic treatments of schizophrenia with more effective strategies to manage medication noncompliance.