정신분열증 환자 치료에서 Risperidone과 Haloperidol의 사용시 치료 비용 비교
Comparison of Treatment Cost between Risperidone and Haloperidol in the Treatment of Schizophrenia
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초록
연구배경현재 risperidone 과 같은 비전형 항정신병 약물은 모두 양성 증상과 음성 증상을 포함한 정신분열병의 정신증적 증상을 완화시키는데 효과적이며 전형적 항정신병약물에 비하여 부작용이 현저히 적어 정신분열병 치료의 일차 선택 약물로 광범위 하게 사용되고 있다. 그러나 전형적 항정신병 약물에 비해서 가격이 고가인 관계로 치료비용이 증가되어 이로 인한 일부 사회적 논쟁이 일고 있다. 최근 외국의 몇몇 연구들이 비전형 항정신병 약물을 사용했을 때 치료비용과 효과에 대한 연구결과를 보고했다. 그러나 외국과 의료전달 체계, 의료보험 시스템, 치료환경 등의 차이가 있는 한국 현실에 비추어 볼 때 이에 대한 국내 연구가 필요하다. 본 연구에서는 현재 광범위하게 사용되고 있는 대표적인 비전형 항정신병 약물인 risperidone 과 대표적 전형적 항정신병 약물인 haloperidol 을 사용한 정신분열증 환자에서 치료비용에 대한 단순 비교조사를 하고자 한다.
Abstract
Background: Risperidone, one of widely prescribed atypical antipsychotics, has been reported to be effective in alleviating the positive and negative symptoms of schizophrenia and to have less adverse effects than the typical antipsychotics. It has been, however, controversial to recommend the use of the atypical antipsychotic due to its higher cost compared to typical antipsychotics. Recently, the cost-effectiveness of atypical antipsychotics has been reported in several studies abroad, which might be different from Korean medico-social environments such as health delivery system, medical insurance system, and hospital environment. Therefore, cost analysis of atypical antipsychotics is necessary in Korea. In this study, we compared simply the cost of two drugs, risperidone, one of widely used atypical antipsychotics, and haloperidol, one of widely used typical antipsychotics. Method: The prices of both drugs were sought from KIMS published in 2001. The mean daily admission cost was calculated from admission costs of six randomly chosen schizophrenics of three university hospitals. The annual expected treatment cost of both drugs was calculated from twenty-two schizophrenics who had been treated in the one university hospital by evaluating the mean expected admission days and the mean expected number of outpatient visits. Results and conclusion: The five-year expected treatment cost of Risperidone was lower than that of haloperidol when considered admission duration and recurrence rates in spite of its higher price. The cost of typical antipsychotics were even higher if its more frequent adverse effects, more use of adjunct drugs, increase in outpatient visiting frequency, and overall decrease in quality of life were considered. In the future, the prospective randomized controlled trial might be necessary with controlling other affecting variables.