运用药物经济学方法评价2012年版《国家基本药物目录》中的重性精神疾病药物

Evaluation of the Drugs for Serious Mental Illness in National Essential Medicine List of 2012 Edition Using Pharmacoeconomics Method

目的:运用药物经济学评价方法评价2012年版《国家基本药物目录》增补的精神障碍类药物,为重性精神疾病基本药物的遴选提供科学依据。方法:根据不同抗精神疾病药物的限定日剂量(DDD)计算限定日费用(DDC),利用上海市120家样本医院2009-2011年精神障碍类药品销售数据分析不同药物的市场份额;对国内外24篇论文采用文献综述的方法,开展成本-效果的循证评价研究。结果:第二代抗精神疾病药物具有不良反应低的优点,市场份额已占绝对优势且有逐年增加的趋势。成本-效果排序依次为氯氮平、利培酮、奥氮平和喹硫平。结论:将第二代抗精神疾病药物列入2012年版基本药物目录是十分必要的。在基本药物遴选方法中除遵循临床首选和价格外,还要考虑长期治疗的总成本和药物不良反应处理费用,今后在基本药物遴选过程中应更多采用模型分析、性价比分析和药物预算影响分析等方法。

Objective： To evaluate the antipsychotic drugs in National Essential Medicine List of 2012 edition using pharmacoeconomics method so as to provide the scientific evidence for the selection of essential medicines for severe mental illness. Methods：Based on the defined daily dose （DDD） and the daily dose cost （DDC） of different antipsychotic drugs and using the sales data of psychiatric drugs during 2009-2011 from 120 sampled hospitals in Shanghai, the market share of different antipsychotic agents was analyzed. A systematic review was conducted of 24 international and domestic literatures to collect evidence-based cost-effectiveness evaluation results. Results：The second generation antipsychotics are of low rate of side effects and have a predominance market share with a yearly increasing trend. By the comparison of relative cost-effectiveness analysis, the results ranked as clozapine, risperidone, olanzapine and guetiapine. Conclusion：It is necessary to enrol the second generation antipsychotics in National Essential Medicine List of 2012 edition. For the selection of essential medicines, consideration should not only be given to the clinical efficacy and their cost, but also the costs for the long-term treatment and adverse reactions. In the future, more studies should be done on modeling method, value-cost comparison and budget impact analysis.