积极性社区干预治疗精神分裂症患者的成本-效果分析

Active Community Intervention of Schizophrenia Patients: Analysis of Cost and Effectiveness

目的探讨积极性社区干预治疗精神分裂症患者的成本-效果。方法选取2012年12月—2013年2月无锡市南长区重性精神病规范化管理的慢性精神分裂症患者120例,使用随机数字表法将其均分为研究组和对照组,研究组给予积极性社区干预,对照组提供常规社区精神卫生服务,随访观察1年。采用自制社区精神疾病成本调查表、阳性与阴性症状量表(PANSS)、世界卫生组织生命质量测定量表简表(WHOQOL-BREF)对两组患者的治疗成本-效果进行评估。结果两组患者的性别构成、年龄、首次发病年龄、婚姻状态、受教育年限、病程、住院次数、药物剂量、家庭月收入、服药依从性、主要照顾者情况比较,差异均无统计学意义(P>0.05)。两组总成本比较,差异无统计学意义(P>0.05)。研究组社区精神病防治费用、住院费用、住院探视交通费用、家属照顾缺勤费用低于对照组,差异有统计学意义(P<0.05)。干预前两组患者PANSS得分、WHOQOL-BREF得分比较,差异均无统计学意义(P>0.05)。干预后1年时两组PANSS评分减分量(E1)、WHOQOL-BREF评分增分量(E2)比较,差异均有统计学意义(P<0.05)。分别以PANSS得分、WHOQOL-BREF得分为治疗效果进行成本-效果分析,PANSS评分每减少1分、WHOQOL-BREF评分每增加1分,研究组的平均成本-效果比(C/E1和C/E2)均低于对照组。敏感性分析显示,假设总成本下降10%而E1、E2维持不变时,研究组的成本-效果仍低于对照组。结论积极性社区干预能有效改善慢性精神分裂症患者的临床症状和生活质量,较传统社区卫生服务更具有卫生经济学价值,是一种经济有效的社区康复模式,值得推广应用。

Objective To explore the cost- effectiveness of active community intervention（ ACI） for schizophrenia patients. Methods From December 2012 to February 2013,in Nanchang District of Wuxi,120 normalizedly- managed schizophrenia patients were enrolled in this study and divided randomly into groups study,control. The study group were given ACI,the control group given conventional community mental health services. The follow- ups lasted 1 year. Self- made questionnaire for community mental disease cost,positive and negative syndrome scale（ PANSS）,WHOQOL- BREF were used to assess the treatment cost- effectiveness of 2 groups. Results There was no significant difference in gender,age,age of first onset,marital status,years of education,duration,times of hospitalizations,drug dosage,family income,medication compliance,main caregivers between 2 groups（ P〉 0. 05）,or in total cost（ P〉 0. 05）. The costs of community prevention and cure,hospitalization,transport expense for hospital visits,absenteeism fee of caregivers were lower in group study than in control group（ P〈 0. 05）. There was no difference in PANSS,WHOQOL- BREF scores between 2 groups before intervention（ P〉0. 05）,but there was in E1,E21 year after intervention（ P〉 0. 05）. The scores of C /E1,C/E2 were lower in group study than in control group. Sensitivity analysis showed that the cost- effectiveness was lower in group study than in control group. Conclusion ACI,which can effectively improve the clinical symptoms and QOL of chronic schizophrenia patients with higher economical values and is a cost- effective community rehabilitation modality,is worthy of popularization and application.