利培酮与富马酸奎硫平改善精神分裂症患者社会功能的经济学评价

Economic evaluation of risperidone and quetiapine famarate tablets in improving social function in patients with schizophrenia

目的:对利培酮和富马酸奎硫平治疗精神分裂症进行药物经济学评价。方法:选择2004-01/12在广西壮族自治区人民医院心理康复中心住院的首发精神分裂症患者64例,均自愿参加观察。按入院顺序将患者分为2组,利培酮组34例,富马酸奎硫平组30例。利培酮组给予利培酮,1mg/片,开始0.5～1.0mg/d,两周后加至治疗量3.0～6.0mg/d继续治疗。富马酸奎硫平组给予富马酸奎硫平,25mg/片,开始25～100mg/d,两周后加至300～600mg/d继续治疗。入院时均给予常规检查,每月复查1次血常规、肝功能、心电图。两组患者分别于入组时及治疗第8周末评简明精神病量表各1次,分别计算两组患者住院治疗8周后的医疗费用总成本(总成本=床位费+护理费+检查费+药费+副反应成本)。①应用简明精神病量表减分率评估治疗效果。简明精神病量表减分率=犤(入组时分数-第8周末分数)/(入组时分数-18)犦×100%,减分率≥50%为显著进步,减分率>25%但<50%为好转,减分率<25%为无效。有效率=显著进步率+好转率。②不良事件采用治疗时出现的症状量表进行评定,以评分≥2分确定有不良事件。结果:64例患者全部进入结果分析,无脱落。①两治疗方案的总效果比较:利培酮组及富马酸奎硫平组治疗总效果相近犤59%,53%(χ2=0.731,P>0.05)犦。②两治疗方案的人均总成本比较:利培酮组的人均成本显著低于富马酸奎硫平组犤(3598.85±58.79,3778.63±36.49)元,(u=4.000,P<0.01)犦。结论:两治疗方案中,利培酮和富马酸奎硫平改善患者临床症状和社会功能的效果相近,但应用利培酮患者经济负担最小,有利于长期维持及康复治疗,此观点与药物经济学中最小成本分析的理论一致。

AIM： To perform drug economic evaluation of risperidone and quetiapine famarate tablets in the treatment of schizophrenia. METHODS： Sixty-four inpatients with schizophrenia, who were treated at the Center of Mental Rehabilitation, People＇s Hospital of Guangxi Zhuang Autonomous Region from January to December 2004, were selected, and they took part in the observation voluntarily. According to the order of hospitalization, the patients were divided into 2 groups： risperidone group with 34 cases, and quetiapine famarate tablets group with 30 cases. The patients in the risperidone group were treated with risperidone, 1 mg per piece, at the beginning given 0.5-1.0 mg a day, and adding to the dosage of treatment 3.0-6.0 mg a day after two weeks. Those in the quetiapine famarate tablets group were treated with quetiapine famarate tablets, 25 mg per piece, at the beginning given 25-100 mg a day, and adding to 300- 600 mg a day after two weeks. At the moment of hospitalization, they were treated with the routine check, and the blood routine, liver function and electrocardiograph were rechecked once a month. The brief psychiatric rating scale （BPRS） was performed at the moment of entering the group and the end of the 8^th week once, respectively. General cost of the medical cost was calculated after 8 weeks treatment in the two groups （general cost=berth fee＋nursing care fee＋check fee＋drug fee＋associate response cost）. ①The reducing score rate of BPRS was used to evaluate the treatment effect. The reducing score rate of BPRS=[（the score when entering the group-the score at the end of the 8^th week）/（the score when entering the group-18）]×100%. The reducing score rate 〉150% for significant advancement, 〉 25% but 〈 50% for taking a turn for the better, and 〈 25% for ineffective.Efficiency=significant advancement rate ＋ taking a turn for the better rate.② The bad event was evaluated by the symptom scale emerged when treated, and the score ≥2 points meant that there were bad events. RESULTS： Sixty-four patients were all involved in the result analysis without drop. ① Comparison of the general effects of the two treatment methods： The results in the risperidone group and the quetiaoine famarate tablets group were close [59%, 53% （X^2=-0.731, P 〉 0.05）]. ② Comparison of average general cost of the two treatment methods： The average cost in the risperidone group was significantly lower than that in the quetiapine famarate tablets group [（3 598.85±58.79, 3 778.63±36.49） yuan, （u=4.000, P 〈 0.01）]. CONCLUSION： Of the two treatment methods, the effects of risperidone and quetiapine famarate tablets in improving clinical symptom and social function of the patients are close, but the usage of risperidone, which has the mini-cost, has advantage for long-term maintenance and rehabilitative treatment, which is accordance with the theory of minimum cost analysis in drug economic.