摘要
目的:评估家庭治疗改善精神分裂症患者社会功能和生活质量的经济学价值。方法:①选择2003-06/2005-09在广西壮族自治区人民医院心理康复中心住院的精神分裂症患者96例,均符合世界卫生组织国际疾病分类第10版关于精神分裂症的诊断标准,且自愿接受量表评估。②入院时用随机数表法将患者分为2组:家庭治疗组(n=50)与对照组(n=46)。对照组进行药物常规治疗;家庭治疗组在此基础上进行9次家庭治疗,观察6个月。内容包括:以疾病健康教育为主要内容的集体家庭治疗4次;以单个家庭为单位的个别家庭治疗4次;几个家庭参与的集体家庭治疗1次。③两组分别于入组时和治疗6个月后采用简明精神病量表(总分18～126分,分数越高,精神症状越严重)、日常生活能力量表(总分14～56分,分数越高,日常生活能力越差)、健康状况调查问卷(0～100分,分数越高,生活质量越高)评估患者精神状态、日常生活能力和健康状况,将各量表评分的变化作为效果。④分别计算两组患者6个月内的医疗费用总成本,简明精神病量表/日常生活能力量表减分量(E1,E2)(入组时简明精神病量表/日常生活能力量表分数-治疗6个月末简明精神病量表/日常生活能力量表分数),健康状况调查问卷增分量(E3)(治疗6个月末健康状况调查问卷分数-入组时健康状况调查问卷分数),平均成本-效果比(C/E),增量成本效果比(△C/△E)犤(家庭治疗组的成本-对照组的成本)/(家庭治疗组的效果-对照组的效果)犦。⑤计量资料和计数资料差异比较分别采用t检验和χ2检验。结果:精神分裂症患者96例均进入结果分析。①效果的确定:家庭治疗组E1,E2,E3均明显高于对照组犤家庭治疗组:(29.00±9.67),(17.06±5.00),(16.50±6.20)分;对照组:(20.67±9.48),(11.13±6.01),(10.00±9.36)分,t=2.420,2.994,2.294,P<0.05犦。②成本的确定:家庭治疗组和对照组的人均成本分别为(5797.06±949.52)和(5360.67±1511.96)元。③成本-效果分析结果:家庭治疗组和对照组平均成本-效果比C/E1分别为199.90和259.34,C/E2分别为339.80和481.64,C/E3分别为351.34和536.07;说明取得同等的治疗效果,家庭治疗的成本比对照组的成本少。与对照组比较,家庭治疗组的增量成本效果比△C/△E1为52.39,△C/△E2为73.59,△C/△E3为67.14;说明家庭治疗治疗组多付出的成本是经济的,可以通过少量的成本换取较高的效果。结论:抗精神病药物联合家庭心理治疗,能显著改善精神分裂症患者的临床症状、社会功能和生活质量,比单纯的药物治疗更能节省医疗费用成本,是一种高效低耗的治疗方法。
AIM： To perform the economic evaluation of family therapy （FT） in improving social function and quality of life in the patients with schizophrenia. METHODS： ①Ninety-six inpatients met with the International Classification of Diseases 10^th Revision （ICD-10） for schizophrenia, were selected from Center of Psychological Rehabilitation, the People＇s Hospital of Guangxi Zhuang Autonomous Region from June 2003 to September 2005. ②They were divided into FT group （n=50） and control group （n=46） randomly. Controlled patients were treated with antipsychotics only, while those of FF group were performed antipsychotics combined with FT for 9 times continuously within 6 months, including family psychosocial education （4 times）, individual family intervention （4 times） and comprehensive （once）.③The Brief Psychiatric Rating Scale （BPRS） was used to evaluated the severity of psychological symptom （total score ranged from 18 to 126, and the higher scores indicated the severe symptom）. Activity of Daily Living Scale （ADL） was used to evaluate the activity of daily living （total score was from 14 to 56, and the higher scores indicated the weaker ability of daily living）. And 36-item Short-Form Health survey （SF-36） was used to evaluate the quality of life （grade from 0 to 100, the higher scores indicated the better quality of life）. All the detections took place at baseline and the end of sixth month respectively.④ General cost of the medical expenses was calculated after six-month treatment in the two groups. The reducing scores of BPRS and ADL were used to evaluate the treatment effect （E1, E2： BPRS/ADL scores at baseline - BPRS/ADL scores at the end of sixth month）. The increasing scores of SF-36 were used to evaluate the third treatment effect （E3=SF-36 scores at the end of sixth month - SF-36 scores at baseline）. In addition, the ratio of cost/effect （C/E） and incremental cost effectiveness ratio [ICER, △C/△E=（cost of FT group - cost of control group）/（effect of FT group - effect of control group）] were calculated.⑤The measurement data and enumeration data Were compared with t test and X^2 test separately. RESULTS： Totally 96 patients with schizophrenia were involved in the result analysis.①Effects： E1, E2 and E3 were obviously higher in FT group than in control group [FT group： （29.00±9.67）, （17.06±5.00）, （16.50±6.20） points; control group： （20.67±9.48）, （11.13±6.01）, （10.00±9.36） points, t=2.420, 2.994, 2.294, P 〈 0.05].②Costs： General costs of FT group and control group were （5 797.06±949.52） and （5 360.67±1 511.96） Yuan respectively.（③C/E： The average C/E of two groups： C/E1 were 199.90 and 259.34 respectively, C/E2 were 339.80 and 481.64 respectively, C/E3 were 351.34 and 536.07 respectively. This stated that FT group could decrease the cost than control group did to obtain the equal curative effect. The ICER of FT group： △C/△E1 was 52,39, △C/△E2 was 73,59 and △C/ △E3 was 67,14, compared with control group. This stated that the more cost of FT group was economical and valuable. CONCLUSION： Antipsychotics combined with family psychological therapy can significantly improve the clinical symptoms, social function and quality of life in the patients with schizophrenia, Compared with the simple drug treatment, it is more economical,
出处
《中国临床康复》
CSCD
北大核心
2006年第34期18-21,共4页
Chinese Journal of Clinical Rehabilitation
作者简介
石捷★，男，1967年生．广西壮族自治区柳州市人，1991年广西医科大学毕业，硕士，副主任医师，主要从事精神障碍患者社区康复的研究。
通讯作者：陶建青，广西壮族自治区人民医院心理康复中心，广西壮族自治区南宁市530021
