CAJ | 학술논문

目的：掌握天津市城镇职工医保精神分裂症患者抗精神病药物使用情况及其医疗费用，为临床决策提供参考。方法：本研究数据来源于2008－2010年天津城镇职工基本医疗保险参保人30％随机抽样。在2008－2009年间至少有1次精神分裂症诊断，首次诊断时使用抗精神病药且之后持续参保12个月的患者被纳入研究。描述抗精神病药使用类型和个数，并对医疗费用进行分析。结果：接受抗精神病药治疗的1739例精神分裂症患者作为研究样本。患者纳入研究时，1461例（84.0％）使用单一抗精神病药治疗；747例（43.0％）使用第一代抗精神病药，813例（46.8％）使用第二代抗精神病药，179例（10.2％）同时使用第一代和第二代两种抗精神病药。在随访12个月内，1387例（79.8％）患者坚持使用与首次药物处方同类型的抗精神病药物。患者年人均医疗费用为（12498.9±14575.2）元，其中仅使用第二代抗精神病药患者的年人均医疗费用低于仅使用第一代抗精神病药的患者[（9064.1±13209.8）元vs.（11928.6±13767.4）元，P＜0.001]，此外12个月期间使用过第一代和第二代抗精神病药患者的年人均医疗费用为（18821.8±15702.7）元。结论：精神分裂症患者在药物治疗时以使用单一抗精神病药为主；第一代和第二代抗精神病药均处于重要地位；在接受药物治疗过程中，大部分患者坚持使用与首次处方同类型的抗精神病药。相比使用第一代抗精神病药的患者，使用第二代抗精神病药患者的总医疗费用较低。
목적：장악천진시성진직공의보정신분렬증환자항정신병약물사용정황급기의료비용，위림상결책제공삼고。방법：본연구수거래원우2008－2010년천진성진직공기본의료보험삼보인30％수궤추양。재2008－2009년간지소유1차정신분렬증진단，수차진단시사용항정신병약차지후지속삼보12개월적환자피납입연구。묘술항정신병약사용류형화개수，병대의료비용진행분석。결과：접수항정신병약치료적1739례정신분렬증환자작위연구양본。환자납입연구시，1461례（84.0％）사용단일항정신병약치료；747례（43.0％）사용제일대항정신병약，813례（46.8％）사용제이대항정신병약，179례（10.2％）동시사용제일대화제이대량충항정신병약。재수방12개월내，1387례（79.8％）환자견지사용여수차약물처방동류형적항정신병약물。환자년인균의료비용위（12498.9±14575.2）원，기중부사용제이대항정신병약환자적년인균의료비용저우부사용제일대항정신병약적환자[（9064.1±13209.8）원vs.（11928.6±13767.4）원，P＜0.001]，차외12개월기간사용과제일대화제이대항정신병약환자적년인균의료비용위（18821.8±15702.7）원。결론：정신분렬증환자재약물치료시이사용단일항정신병약위주；제일대화제이대항정신병약균처우중요지위；재접수약물치료과정중，대부분환자견지사용여수차처방동류형적항정신병약。상비사용제일대항정신병약적환자，사용제이대항정신병약환자적총의료비용교저。
Objective:To describe antipsychotic medication prescription patterns and estimate the associated costs for patients with schizophrenia in Tianjin,China. Methods:Data were 30%random sampling from the Tianjin Urban Employee Basic Medical Insurance (UEBMI)database. Adult patients with≥ 1 diagnosis of schizophrenia, antipsychotics prescribed at the first diagnosis of schizophrenia (index date),and 12-month continuous enrollment after the first antipsychotic prescription (follow-up period)between 2008 and 2010 were included. The classes and number of antipsychotics patients prescribed at index date and patterns of antipsychotics patients maintained/changed during the study period were described. The total direct medical costs were also estimated. Results:Among 2125 patients with schizophrenia,1739 (81. 8%)prescribed with antipsychotic medication prescriptions were in-cluded. At the index date,1461 (84. 0%)of the patients prescribed with one antipsychotic medication,278 (16. 0%)with more than two antipsychotics,and 747 (43. 0%)were prescribed with first-generation antipsychot-ics,813 (46. 8%)with second-generation antipsychotics and 179 (10. 2%)with both. During the following 12 months,1387 (79. 8%)patients remained on the index antipsychotic class. The total cost for 1739 patients was (12498. 9 ±14575. 2)CNY. The total direct medical cost was significantly lower for patients only prescribed with second-generation antipsychotics compared with ones only with first-generation antipsychotics [(9064. 1 ±13209. 8) CNY vs. (1 1928. 6 ±13767. 4)CNY,P<0. 001 ]. In addition,the cost for patients prescribed with first-generation and second-generation antipsychotics was 18821. 8 ±15702. 7 CNY. Conclusion:Majority of patients are prescribed with monotherapy,and tend to stay with one antipsychotic medication class. The total medical cost for patients with second-generation antipsychotic medications is lower than first-generation ones.