居家精神分裂症患者标准化治疗药品费用估算

Estimation of medicine cost for outpatients with schizophrenia based on standardized treatment plan

目的:探讨精神分裂症的标准化治疗方案,估算居家精神分裂症患者年药品费用,为精神卫生救治救助政策制订提供依据。方法:采用德尔菲法,对42名精神卫生专业人员进行三轮专家咨询,其中三甲医院临床精神病学专家12名,省、市、县级精神科临床病房主任30名,形成标准化治疗方案,据此估算居家精神分裂症患者日均和年药品费用。结果:形成的精神分裂症标准化治疗方案为:第一代抗精神病药品用奋乃静18mg/d或氯丙嗪400mg/d合并苯海索4mg/d,第二代抗精神病药品用利培酮4mg/d或奥氮平12.5mg/d合并苯海索3mg/d,难治性患者治疗方案为氯氮平250mg/d联合利培酮4mg/d;使用比例分别为15%、65%和20%,估算出居家患者使用国产药品平均费用为5.16元/d,1883元/年。结论:居家精神分裂症患者年均药品费用在2000元以内,各地应多渠道筹资,提高对严重精神障碍患者的门诊用药保障。

Objective:To explore the standardized treatment plan for schizophrenia patients and estimate the annual medicine cost,to provide evidence for mental health policy formulation.Methods:Usin Delphi method,42 mental health professionals,including 12 senior psychiatrists and 30 wad directors from provincial,municipal and county psychiatric hospital,through three rounds of expert consultation to form a standardized treatment plan.According to this plan,the medication cost of patients with schizophrenia were counted.Results:In the standad treatment plan,the first-generation antipsychotics were perphenazine 18 mg/d or chlorpromazine 400 mg/d,combined with trihexyphenidate 4 mg/d.The second-generation antipsychotics were risperidone 4 mg/d or olanzapine 12.5 mg/d,combined with trihexyphenidate 3 mgd.The treatment plan for refractory patients was clozapine 250 mg/d combined with risperidone 4mg/d.The proportion of patients treated with first-and second-generation antipsychotics and refractory patients were 15%,65%,and 20%,respectively.According to the standardized treatment plan,the average medicine cost for schizophrenia patient was 5.16 yuan/d,and the annual cost was 1883 yuan.Conclusion:The estimated annual medicine cost for patients with schizophrenia is less than 2000 yuan.Local gvernment should increase investment on medication for outpatients with severe mental disorders.