藥物經濟學在醫院藥品選擇的應用：以非典型抗精神病藥物為例

Pharmacoeconomic Application in Drug Selections for Hospital: Illustrated with Atypical Antipsychotic Drugs

李逸鴻(Yi-Hung Lee)

指導教授 ： 李勇進

高雄醫學大學/藥學院/藥學研究所碩士在職專班/碩士(2006年)

摘要

本研究的目的係以醫院藥事委員會的觀點執行藥物經濟學之成本效果分析，以非典型抗精神病藥物作為研究探討藥物經濟學應用在處方集管理的可行性。本研究之治療期間為期二十六週。當二十六週慢性抗精神分裂症治療所產生之所有可能的治療成本之資料可獲得時，均須納入考慮，該治療成本包括整體藥物治療成本、假設十三次的醫師診察費用及其他費用。非典型抗精神病藥物之藥物治療效果資料係取自一篇已發表的整合性參考文獻，並以正性和負性症狀量表（PANSS）或是簡短精神量表（BPRS）作為評估藥物治療效果的指標。根據最近發表之臨床文獻，本研究假設藥物治療效果在種族間的差異很小，甚至可以被忽略。藥物單價係取自2005年8月24日台灣地區中央健康保險局網站公告之資料，至於非典型抗精神病藥物治療劑量之選擇則依據2005年世界衛生組織之定義日劑量。Clozapine不納入比較係因在其他藥物治療失敗時其為抗精神分裂治療之最後選擇，而Sertindole因從市場上被撤銷亦不納入。以二十六週的藥物治療成本執行敏感度分析。從成本效果 （C/E）比值所獲得之結果顯示：zotepine的C/E比值最低(3,258,846元/藥物治療效果)，其次為amisulpride (3,552,182元/藥物治療效果), risperidone (4,470,612元/藥物治療效果), olanzapine (5,013,281元/藥物治療效果) , ziprasidone (5,980,000元/藥物治療效果), clozapine (6,854,706元/藥物治療效果), quetiapine為最高(8,568,750元/藥物治療效果)。另與基準藥物zotepine相比，其邊際成本效果比值 (ICER) 之結果由低至高依序為amisulpride (8,636,666元/藥物治療效果)，其次為olanzapine（12,615,833元/藥物治療效果）。
經由上述C/E比值之結果可知，非典型抗精神病藥物以zotepine最符合成本效果，至於ICER則以amisulpride最佳。此外，本研究結果發現在非典型抗精神病物治療方面，藥品費用仍是直接醫療成本之主要支出。本研究結果在未來可能被質疑的是如有證據顯示藥物治療效果會因種族因素而改變。結論，藥物經濟學分析使用在本研究似乎是一個可行的方法，並用來支持非典型抗精神病藥物在處方集管理。

關鍵字

處方集 ； 藥物經濟學 ； 成本效果分析法 ； 非典型抗精神病藥物

並列摘要

The purpose of this study was to investigate the possibilities of applying pharmacoeconomics (PE) to the hospital formulary management using atypical antipsychotic drugs as the study drug. Cost-effectiveness analysis of PE was performed from the Pharmacy and Therapy Committee point of view. Twenty-six weeks therapy duration was set as the treatment course in this study. All possible costs resulted from 26-week chronic antipsychotic therapy, including total drug costs, costs of assumed 13 clinical visits and others, were taken into consideration when they were available to obtain. The efficacy data of these atypical antipsychotic drugs were obtained from a published systemic review reference, with PANSS or BPRS as the surrogate marker. Based on the currently published clinical research, differences of drug efficacy due to ethnicity were assumed to be so small that could even be ignored in this study. The unit drug price was obtained from the website of National Health Insurance, Taiwan, R.O.C., on the date of August 24, 2005. The selective treatment doses for these atypical antipsychotic drugs were based on the defined daily dose (DDD) published by WHO in 2005. Clozapine was not included for comparison, because it is the final drug of choice for antipsychotic therapy when others are failed. Sertindole was also excluded because of its withdrawal from marketplace. A sensitivity test was conducted based on drug cost resulted from 26-weeks therapy. The results obtained from C/E ratio are shown as following: zotepine (NT$3,258,846, the lowest C/E ratio), amisulpride (NT$3,552,182), risperidone (NT$4,470,612), olanzapine (NT$5,013,281), ziprasidone (NT$5,980,000), and quetiapine (NT$8,568,750 the highest). Compared with zotepine, the sequences from the lowest to the highest cost based on ICER was amisulpride (NT$8,636,666) followed by olanzapine (NT$12,615,833).
The results of C/E ratio showed that the most cost-effective drug among these atypical antipsychotics was zotepine. To compare with zotepine, the best results of ICER was amisulpride. With result of this research the cost of drug was a major factor contributed to total medical costs. The results obtained from this study may be challenged when there is evidence shown that the drug efficacies are varied due to ethnical factor in the future. In conclusion, the PE analysis used in this study seems feasible to support the hospital formulary management for the selection of atypical antipsychotic drugs.

並列關鍵字

hospital formulary ； pharmacoeconomics ； cost-effectiveness ； atypical antipsychotic drugs

參考文獻

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