锂盐联合喹硫平与氯氮平应用于双相躁狂发作的药物经济学评价

Pharmacoeconomics Evaluation of Lithium Combined with Quetiapine versus Clozapine in the Treatment of Maniac Episode of Bipolar Disorder

目的:对锂盐联合二代抗精神病药喹硫平与氯氮平的治疗方案做药物经济学评价,为双相躁狂发作患者临床合理用药提供参考。方法:选取2015年1月~2019年10月于安徽某三级精神专科医院就诊的双相躁狂患者的病历资料进行回顾性分析。在综合考虑患者治疗前后贝克-拉范森躁狂量表(BRMS)评分以及不良反应发生情况的基础上,对锂盐联合喹硫平与锂盐联合氯氮平这两种治疗方案进行药物经济学评价。结果:锂盐联合喹硫平组共纳入有效病例88例,锂盐联合氯氮平组纳入病例43例。两组药物治疗的缓解率差异无统计学意义(P>0.05),锂盐联合喹硫平组的不良反应发生率更低。最小成本分析结果显示锂盐联合喹硫平组住院成本低于锂盐联合氯氮平组。敏感性分析结果与基本分析保持一致。结论:锂盐联合氯氮平药物成本低,但是住院总成本显著高于锂盐联合喹硫平组。故锂盐联合喹硫平相对于锂盐联合氯氮平治疗双相情感障碍躁狂发作更具有经济性。

Objective:To evaluate the pharmacoeconomics of the treatment regimens of lithium combined with the second generation antipsychotic quetiapine or clozapine, so as to provide evidences for rational clinical drug use for maniac episode of bipolar disorder. Methods:This was a retrospective study collecting clinical data from patients with maniac episode of bipolar disorder who received treatment at a third-level psychiatric hospital in Anhui province from January 2015 to October 2019. Based on comprehensive consideration of the pretreatment and posttreatment Bech-Rafaelsen Mania Rating Scale(BRMS) scores and the occurrence of adverse reactions, cost-effectiveness analysis of two treatment regimens, lithium combined with quetiapine and lithium combined with clozapine. Results: Lithium combined with quetiapine group included a total of 88 valid subjects;lithium combined with clozapine group included a total of 43 valid subjects. There was no significant difference in the remission rate of therapy between the two groups(P>0.05), and the incidence of adverse reactions was lower in the lithium combined with quetiapine group. The result of cost-minimization analysis showed that hospitalization costs were lower in the lithium combined with quetiapine group than in the lithium combined with clozapine group. The results of the sensitivity analysis remained consistent with the basic analysis.Conclusion:Lithium combined with clozapine had a lower cost, but the total hospitalization cost was significantly higher than that of the lithium combined with quetiapine group. Therefore, lithium combined with quetiapine is more economical than lithium combined with clozapine in the treatment of manic episodes in bipolar disorder.