朱晓晨 陈彦瑾 韩晟

中图分类号 R956;R749.3 文献标志码 A 文章编号 1001-0408（2021）10-1252-05

DOI 10.6039/j.issn.1001-0408.2021.10.16

摘 要 目的：评估哌罗匹隆治疗精神分裂症的经济性，为临床合理、经济用药和相关卫生决策提供参考。方法：基于医保支付方视角构建短期决策树模型，考虑药物治疗过程中出现的锥体外系反應、体质量增加、糖尿病、高脂血症等主要不良事件，计算不同治疗方案的成本和健康产出。使用质量调整生命年（QALYs）作为健康产出指标，以3倍人均国内生产总值（GDP）作为意愿支付阈值，分别比较哌罗匹隆与喹硫平、阿立哌唑、奥氮平的成本-效用，并进行概率敏感性分析。结果：基础分析结果显示，哌罗匹隆的成本（6 688.25元）低于喹硫平（9 887.45元）、阿立哌唑（13 284.65元）和奥氮平（15 332.80元），其效用（0.79 QALYs）优于喹硫平（0.76 QALYs）、阿立哌唑（0.77 QALYs）和奥氮平（0.75 QALYs）;相比喹硫平、阿立哌唑和奥氮平，哌罗匹隆成本更低而健康产出更高，与上述3种不同治疗方案相比均为绝对优势方案。敏感性分析支持基础分析结果的稳健性。结论：相比其他常用的新型非典型抗精神病药物，精神分裂症患者使用哌罗匹隆是一种更具经济优势的方案。

关键词 精神分裂症;哌罗匹隆;决策树模型;成本-效用分析;药物经济学评价

Pharmacoeconomic Evaluation of Perospirone in the Treatment of Schizophrenia： A Study Based on Major Adverse Events

ZHU Xiaochen1，CHEN Yanjin2，HAN Sheng1（1. International Research Center for Medicinal Administration， Peking University，Beijing 100191，China;2. School of Health Economics and Management， Nanjing University of Chinese Medicine，Nanjing 210023，China）

ABSTRACT   OBJECTIVE：To evaluate the economy of perospirone in the treatment of schizophrenia， to provide guidance for clinically proper use of medications more cost-effectively， and related health decision-making. METHODS： A short-term decision tree model was constructed from the perspective of medical insurance payer to calculate the cost and health outcomes of different treatment plans considering major adverse events including extrapyramidal reaction， weight gain， diabetes， hyperlipidemia. The cost-utility of perospirone were compared with quetiapine， aripiprazole and olanzapine respectively， using QALYs as the measure of health outcomes， 3 times GDP per capita as the willingness-to-pay threshold; probability sensitivity analysis was performed. RESULTS： The results of base-case analysis showed that the cost of perospirone（6 688.25 yuan） was lower than those of quetiapine（9 887.45 yuan）， aripiprazole（13 284.65 yuan）and olanzapine（15 332.80 yuan）. The utility of perospirone（0.79 QALYs） was better than those of quetiapine（0.76 QALYs）， aripiprazole（0.77 QALYs）and olanzapine（0.75 QALYs）. Compared with quetiapine， aripiprazole and olanzapine， peropirone had lower cost and higher health outcome， which indicated that strong dominance favors perospirone over the other 3 drugs. The results of sensitivity analysis were consistent with those of base-case analysis. CONCLUSIONS： Perospirone has economic advantages in treating schizophrenia patients compared to other commonly used atypical antipsychotic drugs.

KEYWORDS   Schizophrenia; Perospirone; Decision tree model; Cost-utility analysis; Pharmacoeconomic evaluation

精神分裂癥（Schizophrenia）好发于青壮年，是一种复发率高、致残率高的慢性迁延性精神疾病，患者常有知觉、思维、情感和行为等方面的障碍[1-2]。2019年的中国精神卫生调查结果显示，精神分裂症及其他精神病性障碍的加权终生患病率为0.7%[3];同时，有研究指出，全球主要国家由精神分裂症造成的年度经济损失占国内生产总值（GDP）的0.02%～1.65%不等，给患者家庭及社会均带来了沉重的负担[4]。……