免费服用利培酮对首发精神分裂症病人干预的成本-效果分析
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摘要
目的探讨免费服用利培酮对首发精神分裂症病人的成本-效果。方法选取2014年10月至2015年5月上海市浦东某社区重性精神病规范化管理的首发精神分裂症病人100例,采用随机数字表法均分为干预组和对照组各50例。对照组给予常规门诊服务和自费购买利培酮;干预组除接受常规门诊服务外,还接受免费的利培酮和社区随访等服务;随访观察周期为1年。采用自制成本调查表、大体评定量表(GAS)对两组的成本-效果进行评价。结果干预前,干预组和对照组的GAS评分、病情情况差异无统计学意义。经1年干预后,两组的成本差异无统计学意义,干预组的GAS评分和病情控制率高于对照组。分别以GAS评分和控制率为干预效果进行成本-效果评价,发现干预组的平均成本-效果比均低于对照组;增量成本-效果(△C/△E)分别为30.89元和8.58元。结论在传统的常规门诊基础上,对首发精神分裂症病人进行免费的利培酮和社区干预等服务措施,可以显著改善病人的病情,是一种经济有效的干预措施。
Objective To explore the cost and effectiveness of free resperidone in patients with first-episode schizophrenia.Methods 100 first-episode schizophrenic patients,who were managed with severe mental disorder in the communities of Pudong aera,Shanghai,were selected from October 2014 to May 2015.The subjects were randomly divided into the intervention group(50 cases) and the control group(50 cases).The control groups were given regular outpatient service and self-paying risperidone.In addition to regular outpatient service,the intervention groups received free risperidone and community follow-up.The follow-up period was one year.The cost-effectiveness of the two groups was evaluated by using the self-made cost questionnaires and the Global Assessment Scale(GAS).Results There were no significant differences in GAS score and severity of illness between the two groups.After 1 year of intervention,the average cost between the two groups was not significantly different,and the GAS score and control rate of disease in the intervention group were higher than those in the control group.The indices of cost and effectiveness of the intervention were evaluated by GAS score and control rate of disease,respectively.In this study,we found the cost and effectiveness was lower in the intervention group than that in the control group.The incremental cost-effectiveness was 30.89 RMB,8.58 RMB,respectively.Conclusion The intervention,which was performed by free risperidone and community follow-up in addition of the traditional routine outpatient service,could significantly improve the patient's condition.Thus,this intervention is an economic and effective measure for schizophrenia.
Objective To explore the cost and effectiveness of free resperidone in patients with first-episode schizophrenia.Methods 100 first-episode schizophrenic patients,who were managed with severe mental disorder in the communities of Pudong aera,Shanghai,were selected from October 2014 to May 2015.The subjects were randomly divided into the intervention group(50 cases) and the control group(50 cases).The control groups were given regular outpatient service and self-paying risperidone.In addition to regular outpatient service,the intervention groups received free risperidone and community follow-up.The follow-up period was one year.The cost-effectiveness of the two groups was evaluated by using the self-made cost questionnaires and the Global Assessment Scale(GAS).Results There were no significant differences in GAS score and severity of illness between the two groups.After 1 year of intervention,the average cost between the two groups was not significantly different,and the GAS score and control rate of disease in the intervention group were higher than those in the control group.The indices of cost and effectiveness of the intervention were evaluated by GAS score and control rate of disease,respectively.In this study,we found the cost and effectiveness was lower in the intervention group than that in the control group.The incremental cost-effectiveness was 30.89 RMB,8.58 RMB,respectively.Conclusion The intervention,which was performed by free risperidone and community follow-up in addition of the traditional routine outpatient service,could significantly improve the patient's condition.Thus,this intervention is an economic and effective measure for schizophrenia.
引文
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[13] LEE SH,CHOI TK,SUH S,et al.Effectiveness of a psychosocial intervention for relapse prevention in patients with schizophrenia receiving risperidone via long-acting injection[J].Psychiatry Res,2010,175(3):195-199.
[14] RAN MS,CHAN CL,NG SM,et al.The effectiveness of psychoeducational family intervention for patients with schizophrenia in a 14-year follow-up study in a Chinese rural area[J].Psychol Med,2015,45(10):2197-2204.
[15] 丁小兵,黄建飞.免费服药对贫困精神分裂症患者的疗效分析[J].中国民康医学,2013,25(21):8-10.
[16] 甘大高.免费服药对贫困精神分裂症患者服药依从性及生活质量的影响[J].中国实用医药,2013,8(20):273-274.
[17] 文家松,杨华,易全民.贫困精神病患者免费服药疗效的随访分析[J].现代医药卫生,2009,25(15):2338-2339.
[18] 谢守付,董晔,李奕,等.综合干预对免费服药精神分裂患者疗效的影响研究[J].中国民康医学,2010,22(9):1084-1085.
[19] 胡善联.卫生经济学基本理论与方法[M].北京:人民卫生出版社,1996:96-108.
[20] 孙文会,王文伶,陆秋娟.海口市社区精神分裂症患者干预治疗效果分析[J].中国卫生统计,2011,28(4):442-443.
[21] 吴越,张恒,樊莹莹,等.积极性社区干预治疗精神分裂症患者的成本-效果分析[J].中国全科医学,2014,17(32):3791-3795.
[22] 范晓倩.精神分裂症患者主动式社区干预模式的效果评估与成本效益分析[D].石家庄:河北大学,2016.
[2] RODRIGUES-AMORIM D,RIVERA-BALTANAS T,LOPEZ M,et al.Schizophrenia:A review of potential biomarkers[J].J Psychiatr Res,2017,93:37-49.
[3] CHONG HY,TEOH SL,WU DB,et al.Global economic burden of schizophrenia:a systematic review[J].Neuropsychiatr Dis Treat,2016,12:357-373.
[4] MILLIER A,SCHMIDT U,ANGERMEYER MC,et al.Humanistic burden in schizophrenia:a literature review[J].J Psychiatr Res,2014,54:85-93.
[5] KANE JM.An evidence-based strategy for remission in schizophrenia[J].J Clin Psychiatry,2008,69 (Suppl 3):25-30.
[6] PERKINS DO.Neuroprotection:a new strategy in the treatment of schizophrenia.Early detection and intervention[J].CNS Spectr,2007,12(10 Suppl 18):10-13.
[7] BUCKLEY PF.Neuroprotection:a new strategy in the treatment of schizophrenia.Treatment of first-episode psychosis[J].CNS Spectr,2007,12(10 Suppl 18):7-10.
[8] 朱益,张伟波,王维玲,等.上海市无业贫困精神疾病患者免费服药现况及对策研究[J].中国医药导报,2013,10(34):109-111.
[9] GRANT PM,BREDEMEIER K,BECK AT.Six-Month Follow-Up of Recovery-Oriented Cognitive Therapy for Low-Functioning Individuals With Schizophrenia[J].Psychiatr Serv,2017,68(10):997-1002.
[10] GUO X,ZHANG Z,ZHAI J,et al.Effects of antipsychotic medications on quality of life and psychosocial functioning in patients with early-stage schizophrenia:1-year follow-up naturalistic study[J].Compr Psychiatry,2012,53(7):1006-1012.
[11] WORLD HEALTH ORGANIZATION.Mental Health-Schizophrenia[EB/OL].[2017-07-30].http://www.who.int/mental_health/management/schizophrenia/en/.
[12] BEEBE LH,SMITH K,PHILLIPS C.Effect of a Telephone Intervention on Measures of Psychiatric and Nonpsychiatric Medication Adherence in Outpatients With Schizophrenia Spectrum Disorders[J].J Psychosoc Nurs Ment Health Serv,2017,55(1):29-36.
[13] LEE SH,CHOI TK,SUH S,et al.Effectiveness of a psychosocial intervention for relapse prevention in patients with schizophrenia receiving risperidone via long-acting injection[J].Psychiatry Res,2010,175(3):195-199.
[14] RAN MS,CHAN CL,NG SM,et al.The effectiveness of psychoeducational family intervention for patients with schizophrenia in a 14-year follow-up study in a Chinese rural area[J].Psychol Med,2015,45(10):2197-2204.
[15] 丁小兵,黄建飞.免费服药对贫困精神分裂症患者的疗效分析[J].中国民康医学,2013,25(21):8-10.
[16] 甘大高.免费服药对贫困精神分裂症患者服药依从性及生活质量的影响[J].中国实用医药,2013,8(20):273-274.
[17] 文家松,杨华,易全民.贫困精神病患者免费服药疗效的随访分析[J].现代医药卫生,2009,25(15):2338-2339.
[18] 谢守付,董晔,李奕,等.综合干预对免费服药精神分裂患者疗效的影响研究[J].中国民康医学,2010,22(9):1084-1085.
[19] 胡善联.卫生经济学基本理论与方法[M].北京:人民卫生出版社,1996:96-108.
[20] 孙文会,王文伶,陆秋娟.海口市社区精神分裂症患者干预治疗效果分析[J].中国卫生统计,2011,28(4):442-443.
[21] 吴越,张恒,樊莹莹,等.积极性社区干预治疗精神分裂症患者的成本-效果分析[J].中国全科医学,2014,17(32):3791-3795.
[22] 范晓倩.精神分裂症患者主动式社区干预模式的效果评估与成本效益分析[D].石家庄:河北大学,2016.