1
|
Hudon A, Beaudoin M, Phraxayavong K, Potvin S, Dumais A. Unsupervised Machine Learning Driven Analysis of Verbatims of Treatment-Resistant Schizophrenia Patients Having Followed Avatar Therapy. J Pers Med 2023; 13:jpm13050801. [PMID: 37240971 DOI: 10.3390/jpm13050801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/04/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: The therapeutic mechanisms underlying psychotherapeutic interventions for individuals with treatment-resistant schizophrenia are mostly unknown. One of these treatment techniques is avatar therapy (AT), in which the patient engages in immersive sessions while interacting with an avatar representing their primary persistent auditory verbal hallucination. The aim of this study was to conduct an unsupervised machine-learning analysis of verbatims of treatment-resistant schizophrenia patients that have followed AT. The second aim of the study was to compare the data clusters obtained from the unsupervised machine-learning analysis with previously conducted qualitative analysis. (2) Methods: A k-means algorithm was performed over the immersive-session verbatims of 18 patients suffering from treatment-resistant schizophrenia who followed AT to cluster interactions of the avatar and the patient. Data were pre-processed using vectorization and data reduction. (3): Results: Three clusters of interactions were identified for the avatar's interactions whereas four clusters were identified for the patient's interactions. (4) Conclusion: This study was the first attempt to conduct unsupervised machine learning on AT and provided a quantitative insight into the inner interactions that take place during immersive sessions. The use of unsupervised machine learning could yield a better understanding of the type of interactions that take place in AT and their clinical implications.
Collapse
Affiliation(s)
- Alexandre Hudon
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3J4, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Mélissa Beaudoin
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3J4, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3G 2M1, Canada
| | - Kingsada Phraxayavong
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3J4, Canada
- Services et Recherches Psychiatriques AD, Montreal, QC H1C 1H1, Canada
| | - Stéphane Potvin
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3J4, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Alexandre Dumais
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3J4, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
- Services et Recherches Psychiatriques AD, Montreal, QC H1C 1H1, Canada
- Institut National de Psychiatrie Légale Philippe-Pinel, Montreal, QC H1C 1H1, Canada
| |
Collapse
|
2
|
Lin C, Zhang X, Jin H. The Societal Cost of Schizophrenia: An Updated Systematic Review of Cost-of-Illness Studies. PHARMACOECONOMICS 2023; 41:139-153. [PMID: 36404364 DOI: 10.1007/s40273-022-01217-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Schizophrenia imposes a substantial economic burden on society. This updated systematic review aims to collate the latest societal cost of schizophrenia across countries by reviewing recent cost-of-illness (COI) studies. METHODS An electronic search was conducted across several databases (MEDLINE, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Health Management Information Consortium, and System for Information on Grey Literature) to identify COI studies published from 2016 to 2022. Two independent reviewers selected studies for inclusion. The cost components and estimates reported by included studies were descriptively summarised. All costs were converted to US dollars (2022 values). Study quality was assessed using a checklist adapted from Larg & Moss. RESULTS Twenty-four studies were included (5 from the update review and 19 from the original review), of which only two were conducted for low- and middle-income countries (LMICs). Widespread methodological heterogeneity among included studies was observed. The annual societal cost per person varied from US$819 in Nigeria to US$94,587 in Norway. Productivity losses accounted for 32-83% of the overall societal cost, whilst direct healthcare cost made up 11-87%. The reporting quality of included studies varied. CONCLUSION This review highlights the substantial economic burden of schizophrenia and a lack of COI studies for LMICs. Recommendations on future research, and good practices on improving the methodological and reporting quality of COI research for schizophrenia are provided.
Collapse
Affiliation(s)
- Claire Lin
- King's Health Economics (KHE), Institute of Psychiatry, Psychology and Neuroscience, King's College London, The David Goldberg Centre, Box 024, London, SE5 8AF, UK
| | - Xiaoyu Zhang
- King's Health Economics (KHE), Institute of Psychiatry, Psychology and Neuroscience, King's College London, The David Goldberg Centre, Box 024, London, SE5 8AF, UK
| | - Huajie Jin
- King's Health Economics (KHE), Institute of Psychiatry, Psychology and Neuroscience, King's College London, The David Goldberg Centre, Box 024, London, SE5 8AF, UK.
| |
Collapse
|
3
|
Kotzeva A, Mittal D, Desai S, Judge D, Samanta K. Socioeconomic burden of schizophrenia: a targeted literature review of types of costs and associated drivers across 10 countries. J Med Econ 2023; 26:70-83. [PMID: 36503357 DOI: 10.1080/13696998.2022.2157596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIMS Schizophrenia has the highest median societal cost per patient of all mental disorders. This review summarizes the different costs/cost drivers (cost components) associated with schizophrenia in 10 countries, including all cost types and stakeholder perspectives, and highlights aspects of disease associated with greatest costs. MATERIALS AND METHODS Targeted literature review based on a search of published research from 2006 to 2021 in the United States (US), United Kingdom (UK), France, Germany, Italy, Spain, Canada, Japan, Brazil, and China. RESULTS Sixty-four published articles (primary studies and literature reviews) were included. Comprehensive data were available on costs in schizophrenia overall, with very limited data for individual countries except the US. Most data is related to direct and not indirect costs, with extremely scarce data for several key cost components (adverse events, suicide, long-term care). Total schizophrenia-related per person per year (PPPY) costs were $2,004-94,229, with considerable variability among countries. Indirect costs were the main cost driver (50-90% of all costs), ranging from $1,852 to $62,431 PPPY. However, indirect costs are not collected systematically or incorporated in health technology assessments. Total schizophrenia-related PPPY direct costs were $4,394-31,798, with inpatient cost as the main cost driver (∼20-99% of direct costs). Intangible costs were not reported. Despite limited evidence, total schizophrenia-related costs were higher in patients with than without negative symptoms, largely due to increased costs of medication and medical visits. LIMITATIONS As this was not a systematic review, prioritization of studies may have resulted in exclusion of potentially relevant data. All costs were converted to USD but not corrected for inflation or subjected to a gross domestic product deflator. CONCLUSIONS Direct costs are most commonly reported in schizophrenia. The substantial underreporting of indirect and intangible costs undervalues the true economic burden of schizophrenia from a payer, patient, and societal perspective.
Collapse
|
4
|
A Scoping and Systematic Review of Employment Processes and Outcomes for Young Adults Experiencing Psychosis. Community Ment Health J 2022; 59:728-755. [PMID: 36463531 DOI: 10.1007/s10597-022-01056-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 11/11/2022] [Indexed: 12/07/2022]
Abstract
Young adults who experience psychosis want to work but are less likely to be employed than their peers. Sixty two studies relating to young adults with psychosis and employment were reviewed following a systematic search of five databases: CINAHL, PsycINFO, MEDLINE, SCOPUS and EMBASE. Publication date ranged from 1973 to 2019 with > 70% between 2010 and 2019. Intervention was considered in 29 papers; critical appraisal revealed 90% of these had moderate to good methodological quality with only three RCTs. Of 11 intervention types "Early Intervention" and "Individual Placement and Support" were most common; both demonstrating positive impact on obtaining employment. The review identified minimal participant perspectives and great variability in: terminology used; the reporting of participant attributes; intervention characteristics and ways employment outcomes were measured. Employment processes identified were preparing for, seeking, obtaining, keeping and re-obtaining employment, with current research efforts focused on obtaining work. More focus is required on keeping and re-obtaining employment.
Collapse
|
5
|
Cost of the Illness of Treatment-Resistant Schizophrenia: A Mirror Image Study Comparing Clozapine With Other Antipsychotics. J Clin Psychopharmacol 2021; 41:36-44. [PMID: 33347021 DOI: 10.1097/jcp.0000000000001332] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE/BACKGROUND This study aimed to evaluate and compare the cost of illness in patients with treatment-resistant schizophrenia (TRS) during 3 months before starting clozapine and for the initial 3 months of treatment with clozapine. METHODS/PROCEDURES Fifty-two patients with TRS were evaluated for the cost of illness (direct, indirect, and provider cost) by using a structured questionnaire for the period of 3 months before starting clozapine and then at the end of the 3 months of clozapine therapy. FINDINGS/RESULTS Total treatment cost for the period of 3 months before starting clozapine was Indian rupees (INR) 40,372 (560.72 US dollars), and the total treatment cost for the first 3 months of clozapine therapy was INR 40,553 (563.23 US dollars). At both the assessments, indirect cost formed the main bulk of the total cost, with no significant difference in the indirect cost. The total direct treatment cost reduced from INR 13,931.6 (193.49 US dollars) to INR 8756 (121.61 US dollars), and the difference between the 2 assessments was statistically significant, with an advantage for clozapine. Overall, after starting clozapine, the total direct cost reduced from 34.5% to 21.6%, and the total indirect cost reduced from 54.3% to 40.2%. After starting clozapine, total provider cost increased from 11.2% to 38.2% of the totalcost. IMPLICATIONS/CONCLUSIONS Treatment with clozapine is not associated with a significant increase in the overall treatment cost, in the short term. However, there is a significant reduction in direct treatment costs.
Collapse
|
6
|
Cloutier M, Manceur AM, Guerin A, Aigbogun MS, Oberdhan D, Gauthier-Loiselle M. The societal economic burden of autosomal dominant polycystic kidney disease in the United States. BMC Health Serv Res 2020; 20:126. [PMID: 32070341 PMCID: PMC7029467 DOI: 10.1186/s12913-020-4974-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 02/11/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common inherited kidney diseases characterized by progressive development of renal cysts and numerous extra-renal manifestations, eventually leading to kidney failure. Given its chronic and progressive nature, ADPKD is expected to carry a substantial economic burden over the course of the disease. However, there is a paucity of evidence on the impact of ADPKD from a societal perspective. This study aimed to estimate the direct and indirect costs associated with ADPKD in the United States (US). METHODS A prevalence-based approach using data from scientific literature, and governmental and non-governmental organizations was employed to estimate direct healthcare costs (i.e., medical services, prescription drugs), direct non-healthcare costs (i.e., research and advocacy, donors/recipients matching for kidney transplants, transportation to/from dialysis centers), and indirect costs (i.e., patient productivity loss from unemployment, reduced work productivity, and premature mortality, caregivers' productivity loss and healthcare costs). The incremental costs associated with ADPKD were calculated as the difference between costs incurred over a one-year period by individuals with ADPKD and the US population. Sensitivity analyses using different sources and assumptions were performed to assess robustness of estimates and account for variability in published estimates. RESULTS The estimated total annual costs attributed to ADPKD in 2018 ranged from $7.3 to $9.6 billion in sensitivity analyses, equivalent to $51,970 to $68,091 per individual with ADPKD. In the base scenario, direct healthcare costs accounted for $5.7 billion (78.6%) of the total $7.3 billion costs, mostly driven by patients requiring renal replacement therapy ($3.2 billion; 43.3%). Indirect costs accounted for $1.4 billion (19.7%), mostly driven by productivity loss due to unemployment ($784 million; 10.7%) and reduced productivity at work ($390 million; 5.3%). Total excess direct non-healthcare costs were estimated at $125 million (1.7%). CONCLUSIONS ADPKD carries a considerable economic burden, predominantly attributed to direct healthcare costs, the majority of which are incurred by public and private healthcare payers. Effective and timely interventions to slow down the progression of ADPKD could substantially reduce the economic burden of ADPKD.
Collapse
Affiliation(s)
| | | | | | | | - Dorothee Oberdhan
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ USA
| | | |
Collapse
|
7
|
Oloniniyi IO, Akinsulore A, Aloba OO, Mapayi BM, Oginni OA, Makanjuola R. Economic Cost of Schizophrenia in a Nigerian Teaching Hospital. J Neurosci Rural Pract 2019; 10:39-47. [PMID: 30765969 PMCID: PMC6337973 DOI: 10.4103/jnrp.jnrp_210_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective: This study evaluated the economic cost of schizophrenia in Nigerian patients and identified factors that influence cost. Methods: A total of 100 participants with schizophrenia were assessed using the modified economic cost questionnaire, the mini-international neuropsychiatric interview, the positive and negative syndrome scale, the Liverpool University Neuroleptic side-effect rating scale, and the global assessment of functioning scale. Associations between sociodemographic characteristics, illness-related variables and direct, indirect, and total costs of schizophrenia were assessed. Results: The average annual total, direct, and indirect costs of the treatment were $818.48, $349.59, and $468.89, respectively, per patient. The direct cost constituted 42.7%, while the indirect cost was 57.3% of the total costs of treatment. Hospitalization was the leading contributor to the direct cost, while productivity loss was a major component of the indirect cost. Conclusion: Schizophrenia is an expensive disease in Nigeria, measures to reduce hospitalization could significantly reduce the cost of illness to the patient and their relatives.
Collapse
Affiliation(s)
- Ibidunni Olapeju Oloniniyi
- Department of Mental Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria.,Department of Mental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Adesanmi Akinsulore
- Department of Mental Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria.,Department of Mental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Olutayo Olubunmi Aloba
- Department of Mental Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria.,Department of Mental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Boladale Moyosore Mapayi
- Department of Mental Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria.,Department of Mental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Olakunle Ayokunmi Oginni
- Department of Mental Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria.,Department of Mental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Roger Makanjuola
- Department of Mental Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria.,Department of Mental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| |
Collapse
|
8
|
Abstract
BACKGROUND Cost-of-illness (COI) studies provide useful information on the economic burden that schizophrenia imposes on a society. OBJECTIVES This study aims to give a general overview of COI studies for schizophrenia and to compare the societal cost of schizophrenia across countries. It also aims to identify the main cost components of schizophrenia and factors associated with higher societal cost to improve the quality and reporting of COI studies for schizophrenia. METHODS We performed an electronic search on multiple databases (MEDLINE, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Health Management Information Consortium [HMIC] and the System for Information on Grey Literature [openSIGLE]) to identify COI studies of schizophrenia published between 1996 and 2016. The primary outcome of this review was societal cost per schizophrenia patient, by cost component. All costs were converted to $US, year 2015 values. RESULTS We included 19 studies in this review. The annual societal cost per patient varied from $US5818 in Thailand to $US94,587 in Norway; whereas the lifetime societal cost per patient was estimated to be $US988,264 in Australia (all year 2015 values). The main cost drivers were direct healthcare costs and productivity losses. Factors associated with higher individual costs included patient demographics, severity of disease and methods used to calculate the costs of productivity losses and comorbidities. CONCLUSIONS This review highlights the large economic burden of schizophrenia. The magnitude of the cost estimates differs considerably across countries, which might be caused by different economic conditions and healthcare systems and widespread methodological heterogeneity among COI studies. Proposed recommendations based on this review can be used to improve the consistency and comparability of COI studies for schizophrenia.
Collapse
Affiliation(s)
- Huajie Jin
- King's Health Economics (KHE), Institute of Psychiatry, Psychology and Neuroscience at King's College London, Box 024, The David Goldberg Centre, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
| | - Iris Mosweu
- King's Health Economics (KHE), Institute of Psychiatry, Psychology and Neuroscience at King's College London, Box 024, The David Goldberg Centre, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| |
Collapse
|
9
|
Gao L, Hu H, Zhao FL, Li SC. Can the Direct Medical Cost of Chronic Disease Be Transferred across Different Countries? Using Cost-of-Illness Studies on Type 2 Diabetes, Epilepsy and Schizophrenia as Examples. PLoS One 2016; 11:e0147169. [PMID: 26814959 PMCID: PMC4731392 DOI: 10.1371/journal.pone.0147169] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 12/30/2015] [Indexed: 11/18/2022] Open
Abstract
Objectives To systematically review cost of illness studies for schizophrenia (SC), epilepsy (EP) and type 2 diabetes mellitus (T2DM) and explore the transferability of direct medical cost across countries. Methods A comprehensive literature search was performed to yield studies that estimated direct medical costs. A generalized linear model (GLM) with gamma distribution and log link was utilized to explore the variation in costs that accounted by the included factors. Both parametric (Random-effects model) and non-parametric (Boot-strapping) meta-analyses were performed to pool the converted raw cost data (expressed as percentage of GDP/capita of the country where the study was conducted). Results In total, 93 articles were included (40 studies were for T2DM, 34 studies for EP and 19 studies for SC). Significant variances were detected inter- and intra-disease classes for the direct medical costs. Multivariate analysis identified that GDP/capita (p<0.05) was a significant factor contributing to the large variance in the cost results. Bootstrapping meta-analysis generated more conservative estimations with slightly wider 95% confidence intervals (CI) than the parametric meta-analysis, yielding a mean (95%CI) of 16.43% (11.32, 21.54) for T2DM, 36.17% (22.34, 50.00) for SC and 10.49% (7.86, 13.41) for EP. Conclusions Converting the raw cost data into percentage of GDP/capita of individual country was demonstrated to be a feasible approach to transfer the direct medical cost across countries. The approach from our study to obtain an estimated direct cost value along with the size of specific disease population from each jurisdiction could be used for a quick check on the economic burden of particular disease for countries without such data.
Collapse
Affiliation(s)
- Lan Gao
- School of Biomedical Sciences & Pharmacy, The University of Newcastle, Callaghan, NSW, Australia
| | - Hao Hu
- School of Biomedical Sciences & Pharmacy, The University of Newcastle, Callaghan, NSW, Australia
| | - Fei-Li Zhao
- Access and Public Affair, Pfizer Australia, West Ryde, NSW, Australia
| | - Shu-Chuen Li
- School of Biomedical Sciences & Pharmacy, The University of Newcastle, Callaghan, NSW, Australia
- * E-mail:
| |
Collapse
|
10
|
Zaprutko T, Nowakowska E, Kus K, Bilobryvka R, Rakhman L, Pogłodziński A. The cost of inpatient care of schizophrenia in the Polish and Ukrainian academic centers--Poznan and Lviv. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2015; 39:165-173. [PMID: 25216718 PMCID: PMC4361770 DOI: 10.1007/s40596-014-0198-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 06/23/2014] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The authors aimed to analyze and compare treatments of schizophrenia in Poznan and Lviv to present the potential differences between Poland and Ukraine in pharmacotherapy and economic availability of medicines, to emphasize the role of academic centers in the effective treatment of schizophrenia, and to raise the awareness of residents about economics and the cost of inpatient care. METHODS The analysis was based on 307 hospital records of patients treated in 2010 and 2011 and data from the hospital accounting department. Per the inclusion criteria, 108 adult patients (50 in Poznan and 58 in Lviv) were enrolled in the study. Monetary values were converted into euros (EUR) at the rate published by the National Bank of Poland (NBP) on October 9, 2012. RESULTS The total cost of schizophrenia treatment in Poznan was EUR 160,489.26, x = EUR 3,209.78 per patient, and in Lviv it was EUR 30,943.38, x = EUR 533.5 per patient. Treatment schedules differed between Poznan and Lviv, and pharmacotherapy was limited economically, especially in Lviv. CONCLUSION Although the results differ between Poznan and Lviv, the study shows that schizophrenia treatment is expensive in both centers. Differences in the health care systems make use of innovative neuroleptics unavailable especially in Lviv, which may contribute to non-compliance or higher level of relapses. Distinctive efforts to improve therapies should be made and efforts to equalize access to innovative pharmacotherapy should be supported to improve the therapy's efficacy and the economic values of schizophrenia treatment.
Collapse
|
11
|
Ganesan S, McKenna M, Procyshyn RM, Zipursky S. Risperidone long-acting injection in the treatment of schizophrenia spectrum illnesses: A retrospective chart review of 19 patients in the Vancouver Community Mental Health Organization (Vancouver, Canada). Curr Ther Res Clin Exp 2014; 68:409-20. [PMID: 24692772 DOI: 10.1016/j.curtheres.2007.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2007] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Schizophrenia is a chronic debilitating disease that affects ~110,000 Canadians (0.55% lifetime prevalence). Risperidone long-acting injection (RLAI) is the first injectable, long-acting, atypical antipsychotic drug marketed in Canada. OBJECTIVE The aim of this study was to assess the clinical effectiveness and hospitalization rates of patients with schizophrenia, schizoaffective disorder, or schizophreniform disorder treated with RLAI in a community mental health care setting. METHODS Data were collected between August 1, 2006 and September 30, 2006 via a retrospective chart review of outpatients diagnosed with schizophrenia, schizoaffective disorder, or schizophreniform disorder who received treatment from 1 of the 8 mental health teams within the Vancouver Community Mental Health Organization (VCMHO) in Vancouver, British Columbia, Canada. Collected data included: frequency and duration of institutional care, discharge and relapse rates, demographic variables, diagnosis history, RLAI medication history, and history of other medications. The overall severity of symptoms before and after RLAI treatment and the improvement in symptoms during treatment were evaluated using the Clinical Global Impression Scales for severity (CGI-S)(1 = not ill to 7 = extremely ill) and improvement (CGI-I)(1 = very much improved to 7 = very much worse). RESULTS Forty-four patients were identified as having received RLAI. The charts of 19 patients (10 men, 9 women; mean [SD] age at time of chart audit, 36.7 [11.7] years; mean [SD] age at primary diagnosis, 23.6 [7.4] years; race: white, 10 [52.6%]; Asian, 6 [31.6%]; American Indian, 1 [5.3%]; black, 1 [5.3%]; other, 1 [5.3%]) were included in the analysis. The majority of patients (78%) had been treated with another antipsychotic drug prior to treatment with RLAI: risperidone (77%), quetiapine (47%), zuclopenthixol (43%), olanzapine (43%), and loxapine (17%). Mean (SD) CGI-S Scale score declined significantly from 5.29 (1.3) before treatment initiation to 3.05 (1.0) posttreatment (P < 0.001). Mean (SD) CGI-I Scale score was 2.58 (0.71) (P < 0.001); 94% of patients had a CGI-I score ≤3. Mean (SD) duration of hospitalization decreased significantly from 15.7 (19.7) days before treatment to 2.4 (6.0) days after treatment (P < 0.05). Mean (SD) number of hospializations also decreased significantly from 2.0 (1.8) before treatment to 0.5 (1.3) after treatment (P < 0.01). CONCLUSIONS The results of this pilot study suggest that use of the atypical-antipsychotic medication RLAI significantly decreased duration and rates of hospitalization, compared with baseline, in these VCMHO patients with schizophrenia spectrum illnesses.
Collapse
Affiliation(s)
- Soma Ganesan
- University of British Columbia,Vancouver, British Columbia, Canada; Department of Psychiatry, Vancouver General Hospital, Vancouver, British Columbia, Canada; University of British Columbia Hospital, Vancouver, British Columbia, Canada; Adult Mental Health Services, Vancouver Community Mental Health Services, Vancouver, British Columbia, Canada; Riverview Hospital, Cross Cultural Psychiatry Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mario McKenna
- Department of Psychiatry, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Ric M Procyshyn
- Division of Research, Riverview Hospital, Port Coquitlam, British Columbia, Canada ; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sheldon Zipursky
- University of Bristish Columbia, Vancouver, british Columbia, Canada; Adult Mental Health Services, Vancouver Community Mental Health Services, Vancouver, British Columbia, Canada; Department of Psychiatry, Richmond Hospital, Richmond, British Columbia, Canada; Community Mental Health and Addictions, Richmond Health Services, Richmond, British Columbia, Canada
| |
Collapse
|
12
|
Somaiya M, Grover S, Avasthi A, Chakrabarti S. Changes in cost of treating schizophrenia: comparison of two studies done a decade apart. Psychiatry Res 2014; 215:547-53. [PMID: 24495571 DOI: 10.1016/j.psychres.2014.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 01/04/2014] [Accepted: 01/09/2014] [Indexed: 02/08/2023]
Abstract
Objective of this study was to compare the cost of care of schizophrenia estimated in the same catchment area separated by a decade. Cost of care of schizophrenia was estimated in 50 outpatients in 2001-2002 and 53 outpatients 2010-2011 using the same methodology along with structured assessments of psychopathology. Overall cost of care of schizophrenia has doubled in the last one decade. The total direct cost of the treatment has not changed much in the monetary terms in last one decade, but total indirect cost has increased 2.35 times. In terms of proportion of cost, there was no significant change in the proportion of the provider cost, however, the proportion of indirect cost increased from 63% to 77.57% from the year 2001-2002 to the year 2010-2011. Cost of care of schizophrenia is more for those have lower level of functioning and have to visit the hospital more often. Cost of care of schizophrenia in India has doubled in the last one decade.
Collapse
Affiliation(s)
- Mansi Somaiya
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India.
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| |
Collapse
|
13
|
Neil AL, Carr VJ, Mihalopoulos C, Mackinnon A, Morgan VA. Costs of psychosis in 2010: findings from the second Australian National Survey of Psychosis. Aust N Z J Psychiatry 2014; 48:169-82. [PMID: 24097844 DOI: 10.1177/0004867413500352] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To estimate the annual costs of psychosis in Australia from societal and government perspectives and assess whether average costs per person differ by principal service provider at time of census. METHODS Costs of psychosis encompassing health sector costs, other sector costs, and productivity losses were assessed for 2010 using a prevalence-based, bottom-up approach. Resource use data were obtained from the second Australian National Survey of Psychosis and unit costs were from government and non-government organization (NGO) sources. Costs to society were assessed by principal service provider at census: public specialized mental health services (PSMHS) and NGOs during the census month (current clients), and PSMHS in the 11 months preceding census (recent clients), and any differences were ascertained. RESULTS The average annual costs of psychosis to society are estimated at $77,297 per affected individual, comprising $40,941 in lost productivity, $21,714 in health sector costs, and $14,642 in other sector costs. Health sector costs are 3.9-times higher than those for the average Australian. Psychosis costs Australian society $4.91 billion per annum, and the Australian government almost $3.52 billion per annum. There are significant differences between principal service providers for each cost category. Current PSMHS clients had the highest health sector costs overall, and the highest mental health ambulatory, inpatient, and antipsychotic medication costs specifically. NGO clients had the highest other sector costs overall and the highest NGO assistance, supported employment, and supported accommodation costs. Recent PSMHS clients had the lowest productivity losses for reduced participation and the highest costs for absenteeism and presenteeism. CONCLUSIONS The costs of psychosis are broad ranging and very high. Development and implementation of cost-effective prevention, treatment, and support strategies is critical to maximizing the efficiency of service delivery. A needs-based framework based on principal service provider and recency of contact may facilitate this process.
Collapse
Affiliation(s)
- Amanda L Neil
- 1Hobart and Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia
| | | | | | | | | |
Collapse
|
14
|
Lammers L, Zehm B, Williams R. Risperidone long-acting injection in Schizophrenia Spectrum Illnesses compared to first generation depot antipsychotics in an outpatient setting in Canada. BMC Psychiatry 2013; 13:155. [PMID: 23718192 PMCID: PMC3669627 DOI: 10.1186/1471-244x-13-155] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 05/23/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Depot formulations of antipsychotics provide a potential solution to the poor adherence to oral therapies in schizophrenia. However, there have been few comparative studies on the effectiveness and tolerability of first and second generation depot antipsychotics in a real clinical practice setting. The objectives of the present study were to compare safety and outcomes in patients with schizophrenia initiated on risperidone long-acting injection (RLAI) or first generation antipsychotic injections (FGAI) at a Mental Health Centre in British Columbia. METHODS Data were collected by retrospective chart review of all active patients starting depot therapy who were ≥ 18 years of age, had received at least 3 injections of depot antipsychotic and had no prior clozapine treatment. Kaplan Meier survival curves were used to estimate probability of treatment discontinuation and hospitalization. RESULTS A total of 70 RLAI and 102 FGAI patient charts were reviewed. At baseline patients in both groups had similar ages (39.7 and 42.7 years for RLAI and FGAI patients (p = 0.09), respectively) but FGAI patients had a longer time since diagnosis (13.6 vs. 9.85 years (p = 0.003)). Treatment retention at 18 months was 77% for RLAI and 86% for FGAI patients (p = 0.22) and 82% and 88% of patients, respectively (p = 0.28), had not been hospitalized. However, RLAI analyses were compromised by lack of long-term patient data. Concomitant medication utilization was similar in both groups except for anticholinergics which were used less frequently in RLAI patients (5.7% vs. 35.3%, p < 0.001). Adverse event frequency was also similar except for extrapyramidal symptoms (EPS) which were more common in FGAI patients (52.9% vs. 17.0% for RLAI (p < 0.001)). CONCLUSIONS There was no apparent difference in treatment discontinuation or hospitalization between RLAI and FGAI treated patients, although analysis was compromised by low patient numbers. However, decreased EPS with RLAI may offer a significant clinical benefit to patients with schizophrenia.
Collapse
Affiliation(s)
- Laura Lammers
- Pharmacy Department, Nanaimo Regional General Hospital, Vancouver Island Health Authority, Nanaimo, Canada
| | - Bree Zehm
- Pharmacy Department, Royal Jubilee Hospital, Vancouver Island Health Authority, Victoria, Canada
| | - Richard Williams
- Department of Psychiatry, Eric Martin Pavilion, Vancouver Island Health Authority, Victoria, Canada
| |
Collapse
|
15
|
Rice CD, Howard L, Leese M, Jarrett M, Thornicroft G. Determinants of wanting to seek full versus part-time paid employment among people with severe mental illness. J Ment Health 2009. [DOI: 10.3109/09638230902968167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
16
|
López-Bastida J, Perestelo-Pérez L, Montón-Alvarez F, Serrano-Aguilar P. Social economic costs and health-related quality of life in patients with degenerative cerebellar ataxia in Spain. Mov Disord 2008; 23:212-7. [PMID: 17999424 DOI: 10.1002/mds.21798] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
To determine the economic burden (direct and indirect costs), as well as health-related quality of life (HRQOL) in patients diagnosed with spinocerebellar ataxia (SCA) in Spain. A cross-sectional study was carried out on 84 patients with SCA from the Spanish Ataxia Federation (FEDAES) during 2004. A retrospective assessment of the use of resources was obtained through questionnaires filled out by the patients or the patient's caregivers. The approach used was the cost-of-illness study based on a societal perspective. To assess HRQOL in patients with SCA, they were asked to fill out the EQ-5D generic questionnaire. The mean annual cost per patient with SCA was 18,776 euros. The most important categories of costs were informal care, early retirement (permanent disability), medications, and orthopaedic devises. The mean EQ-5D index score was 0.48 (0.38 for high and 0.58 for low severity patients) and the mean EQ-5D VAS score was 48 (43 for high and 52 for low severity patients). Considerations of the costs related to caregivers due to the patients' disabilities, as well as the high indirect costs resulting from permanent disabilities in patients with SCA, should become a priority for health authorities. Furthermore, the patients' quality of life, as determined by the EQ-5D questionnaire, was very low and substantially influenced by the degree of severity of SCA.
Collapse
Affiliation(s)
- Julio López-Bastida
- Planning and Evaluation Service, Canary Islands Health Service, Santa Cruz de Tenerife, Canary Islands, Spain.
| | | | | | | |
Collapse
|
17
|
Lee IH, Chen PS, Yang YK, Liao YC, Lee YD, Yeh TL, Yeh LL, Cheng SH, Chu CL. The functionality and economic costs of outpatients with schizophrenia in Taiwan. Psychiatry Res 2008; 158:306-15. [PMID: 18243334 DOI: 10.1016/j.psychres.2006.10.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2006] [Revised: 07/12/2006] [Accepted: 10/02/2006] [Indexed: 11/27/2022]
Abstract
The aims of this study were to investigate the economic costs of outpatients with schizophrenia in Taiwan, and to survey factors that influence the costs. The direct costs were defined as the costs associated with psychiatric services and other medical treatment. The indirect costs were estimated using the Human Capital Method. Patients' characteristics, including sex, age, duration of education, duration of illness, frequency of hospitalization, type of antipsychotic medication, severity of extrapyramidal side effects caused by antipsychotic medication, and global functions, were used to estimate the costs. The average annual total cost was approximately US$16,576 per patient. The direct and indirect costs were 13% and 87% of the total costs, respectively. Among the direct costs, folk therapy ranked third, just behind prescription drugs and acute ward hospitalization. The productivity loss of both the patients and their caregivers was the major component of the indirect costs. The patient's age and global functions had a significantly negative relationship with the direct costs. The severity of extrapyramidal side effects, type of antipsychotic medication, and the patient's illness duration correlated positively with the indirect costs, while the patient's global function correlated negatively with the indirect costs. Overall, the indirect costs of treating schizophrenia were higher than the direct costs. Improving patients' functionality and decreasing caregivers' burden are essential to reducing costs.
Collapse
Affiliation(s)
- I Hui Lee
- Department of Psychiatry, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, Tainan 70428, Taiwan
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Cañas F, Pérez-Solá V, Díaz S, Rejas J. Cost-effectiveness analysis of ziprasidone versus haloperidol in sequential intramuscular/oral treatment of exacerbation of schizophrenia: economic subanalysis of the ZIMO trial. Clin Drug Investig 2007; 27:633-45. [PMID: 17705572 DOI: 10.2165/00044011-200727090-00005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE This study aimed to assess the cost effectiveness of ziprasidone versus haloperidol in sequential intramuscular (IM)/oral treatment of patients with exacerbation of schizophrenia in Spain. METHODS A cost-effectiveness analysis from the hospital perspective was performed. Length of stay, study medication and use of concomitant drugs were calculated using data from the ZIMO trial. The effectiveness of treatment was determined by the percentage of responders (reduction in baseline Brief Psychiatric Rating Scale [BPRS] negative symptoms subscale >or=30%). Economic assessment included estimation of mean (95% CI) total costs, cost per responder and the incremental cost-effectiveness ratio (ICER) per additional responder. The economic uncertainty level was controlled by resampling and calculation of cost-effectiveness acceptability curves. RESULTS A total of 325 patients (ziprasidone n = 255, haloperidol n = 70) were included in this economic subanalysis. Ziprasidone showed a significantly higher responder rate compared with haloperidol (71% vs 56%, respectively; p = 0.023). Mean total costs were euro3582 (95% CI 3226, 3937) for ziprasidone and euro2953 (95% CI 2471, 3436) for haloperidol (p = 0.039), mainly due to a higher ziprasidone acquisition cost. However, costs per responder were lower with ziprasidone (euro5045 [95% CI 4211, 6020]) than with haloperidol (euro5302 [95% CI 3666, 7791], with a cost per additional responder (ICER) for ziprasidone of euro4095 (95% CI -130, 22 231). The acceptability curve showed an ICER cut-off value of euro13 891 at the 95% cost-effectiveness probability level for >or=30% reduction in BPRS negative symptoms. CONCLUSIONS Compared with haloperidol, ziprasidone was significantly better at controlling psychotic negative symptoms in acute psychoses. The extra cost of ziprasidone was offset by a higher effectiveness rate, yielding a lower cost per responder. In light of the social benefit (less family burden and greater restoration of productivity), the incremental cost per additional responder with sequential IM/oral ziprasidone should be considered cost effective in patients with exacerbation of schizophrenia in Spain.
Collapse
Affiliation(s)
- Fernando Cañas
- Department of Psychiatry, Hospital Rodríguez Lafora, Madrid, Spain
| | | | | | | |
Collapse
|
19
|
Kujala J, Lillrank P, Kronström V, Peltokorpi A. Time-based management of patient processes. J Health Organ Manag 2006; 20:512-24. [PMID: 17168103 DOI: 10.1108/14777260610702262] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to present a conceptual framework that would enable the effective application of time based competition (TBC) and work in process (WIP) concepts in the design and management of effective and efficient patient processes. DESIGN/METHODOLOGY/APPROACH This paper discusses the applicability of time-based competition and work-in-progress concepts to the design and management of healthcare service production processes. A conceptual framework is derived from the analysis of both existing research and empirical case studies. FINDINGS The paper finds that a patient episode is analogous to a customer order-to-delivery chain in industry. The effective application of TBC and WIP can be achieved by focusing on through put time of a patient episode by reducing the non-value adding time components and by minimizing time categories that are main cost drivers for all stakeholders involved in the patient episode. RESEARCH LIMITATIONS/IMPLICATIONS The paper shows that an application of TBC in managing patient processes can be limited if there is no consensus about optimal care episode in the medical community. PRACTICAL IMPLICATIONS In the paper it is shown that managing patient processes based on time and cost analysis enables one to allocate the optimal amount of resources, which would allow a healthcare system to minimize the total cost of specific episodes of illness. Analysing the total cost of patient episodes can provide useful information in the allocation of limited resources among multiple patient processes. ORIGINALITY/VALUE This paper introduces a framework for health care managers and researchers to analyze the effect of reducing through put time to the total cost of patient episodes.
Collapse
Affiliation(s)
- Jaakko Kujala
- Department of Industrial Engineering and Management, Helsinki University of Technology, Espoo, Finland.
| | | | | | | |
Collapse
|
20
|
Smith G, Malla A, Williams R, Kopala L, Love L, Balshaw R. The Canadian National Outcomes Measurement Study in Schizophrenia: overview of the patient sample and methodology. Acta Psychiatr Scand Suppl 2006:4-11. [PMID: 16542320 DOI: 10.1111/j.1600-0447.2006.00756.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The Canadian National Outcomes Measurement Study in Schizophrenia (CNOMSS) is a prospective survey of routine clinical practice. METHOD Patients with schizophrenia or a related disorder were consecutively enrolled from all regions of Canada. Both academic and community psychiatric clinics were included and patients were followed up for 2 years. Clinical and functional status, quality of life, medication and economic costs were assessed at enrollment and monitored throughout the follow-up period. RESULTS Patients attending an academic clinic tended to be younger and more severely ill than those from community clinics. Both types of sites prescribed atypical neuroleptics to more than three-quarters of the patients. The majority of those enrolled were unemployed and living in poverty. Poor clinical status was associated with poverty. CONCLUSION The CNOMSS provides demographic, clinical and treatment-related information about a large Canada-wide sample of psychiatric patients. The following three articles in this issue of Acta Psychiatrica Scandinavica explore issues related to medication, quality of life and resource utilization.
Collapse
Affiliation(s)
- G Smith
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
| | | | | | | | | | | |
Collapse
|
21
|
Oliva-Moreno J, López-Bastida J, Osuna-Guerrero R, Montejo-González AL, Duque-González B. The costs of schizophrenia in Spain. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2006; 7:182-88. [PMID: 16850333 DOI: 10.1007/s10198-006-0350-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
This study estimated the economic impact of schizophrenia-related direct costs (medical and nonmedical costs) in Spain. Direct medical costs (hospitalizations, outpatient consultations, drug costs) and direct nonmedical costs (costs of informal care) were estimated based on prevalence costs for 2002. The total costs of schizophrenia were estimated at euro 1,970.8 million; direct medical costs accounted for 53% and informal care costs 47%. Despite having implemented a conservative approach, the health care costs associated with schizophrenia account for 2.7% of total public health care expenditure in Spain. The sum of medical and nonmedical costs give us a better definition of the magnitude of the problem in Spain as well as contributing to helping make the debate on this issue more transparent.
Collapse
Affiliation(s)
- Juan Oliva-Moreno
- Department of Economics, Universidad Carlos III de Madrid, Fundacion de Estudios de Economia Aplicada (Fedea), Madrid, Spain.
| | | | | | | | | |
Collapse
|
22
|
Kopala L, Smith G, Malla A, Williams R, Love L, Talling D, Balshaw R. Resource utilization in a Canadian national study of people with schizophrenia and related psychotic disorders. Acta Psychiatr Scand 2006:29-39. [PMID: 16542323 DOI: 10.1111/j.1600-0447.2006.00759.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine how the use of the newer, so called atypical antipsychotic medications, effects the pharmacoeconomic treatment burden of schizophrenia and related conditions and to provide a clear comparison of the costs and risks associated with these atypical drugs. METHOD In this 2-year, open-label, prospective study, resource utilization (RU) data were collected on 160 patients with these conditions. A comparison between risks and costs was performed by combining the generalized CNOMSS data on both economic factors and risk assessments. RESULTS The main findings of the study were that the total adjusted 1- and 2-year costs were lowest for quetiapine. Drug acquisition costs were lowest for risperidone for both the 1- and 2-year cohorts. Clozapine use was predictably associated with the highest overall and medication costs at both 1 and 2 years. CONCLUSION Treatment with risperidone or quetiapine was associated with the lowest overall costs when compared with olanzapine or clozapine.
Collapse
Affiliation(s)
- L Kopala
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
| | | | | | | | | | | | | |
Collapse
|
23
|
Leitão RJ, Ferraz MB, Chaves AC, Mari JJ. Cost of schizophrenia: direct costs and use of resources in the State of São Paulo. Rev Saude Publica 2006; 40:304-9. [PMID: 16583042 DOI: 10.1590/s0034-89102006000200017] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To estimate the direct costs of schizophrenia for the public sector. METHODS A study was carried out in the state of São Paulo, Brazil, during 1998. Data from the medical literature and governmental research bodies were gathered for estimating the total number of schizophrenia patients covered by the Brazilian Unified Health System. A decision tree was built based on an estimated distribution of patients under different types of psychiatric care. Medical charts from public hospitals and outpatient services were used to estimate the resources used over a one-year period. Direct costs were calculated by attributing monetary values for each resource used. RESULTS Of all patients, 81.5% were covered by the public sector and distributed as follows: 6.0% in psychiatric hospital admissions, 23.0% in outpatient care, and 71.0% without regular treatment. The total direct cost of schizophrenia was US $191,781,327 (2.2% of the total health care expenditure in the state). Of this total, 11.0% was spent on outpatient care and 79.2% went for inpatient care. CONCLUSIONS Most schizophrenia patients in the state of São Paulo receive no regular treatment. The study findings point out to the importance of investing in research aimed at improving the resource allocation for the treatment of mental disorders in Brazil.
Collapse
Affiliation(s)
- Raquel Jales Leitão
- Departamento de Psiquiatria, Universidade Federal de São Paulo, Rua Borges Lagoa 1080 sala 1407, 04038-032 São Paulo, SP, Brazil.
| | | | | | | |
Collapse
|
24
|
Lee HC, Tsai SY, Lin HC, Chen CC. The association between psychiatrist numbers and hospitalization costs for schizophrenia patients: a population-based study. Schizophr Res 2006; 81:283-90. [PMID: 16309896 DOI: 10.1016/j.schres.2005.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2005] [Revised: 09/29/2005] [Accepted: 10/11/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study explores the association between psychiatrist case volumes and costs for hospitalized schizophrenia patients. METHODS The study uses the Taiwan National Health Insurance Research Database for 2003, identifying the study subjects from the database by ICD-9-CM principal diagnosis code 295. Our study sample comprises of 135,621 admissions treated by 787 psychiatrists in 181 hospitals, with the sample being divided equally into three psychiatrist volume groups: <or=300 (low volume), 301-600 (medium volume) and >or=601 admissions (high volume). After adjusting for psychiatrist, patient and hospital characteristics, multiple regression analyses were performed to determine the association between psychiatrist case volume and hospitalization costs (total, drug, and non-drug). RESULTS The regression analyses showed that after adjusting for psychiatrist, patient and hospital characteristics, average treatment costs associated with hospitalized schizophrenia patients were inversely related to psychiatrist volume. The respective total costs, drug costs and non-drug costs of patients treated by high-volume psychiatrists were 369 US dollars (p<0.001), 26 US dollars (p<0.001) and 343 US dollars (p<0.001) lower than those of low-volume psychiatrists. The respective total costs, drug costs and non-drug costs for those treated by medium-volume psychiatrists were 248 US dollars (p<0.001), 22 US dollars (p<0.001) and 226 US dollars (p<0.001) lower than those of low-volume psychiatrists. CONCLUSIONS We find that after adjusting for patient, psychiatrist and hospital characteristics, an inverse volume-cost relationship exists for psychiatrists treating schizophrenia patients. Further studies should aim to investigate the volume-quality relationship to ensure that incremental cost savings associated with increased patient volume are not achieved at the expense of quality of patient care.
Collapse
Affiliation(s)
- Hsin-Chien Lee
- Taipei Medical University Hospital, Department of Psychiatry, Taipei, Taiwan.
| | | | | | | |
Collapse
|
25
|
Akobundu E, Ju J, Blatt L, Mullins CD. Cost-of-illness studies : a review of current methods. PHARMACOECONOMICS 2006; 24:869-90. [PMID: 16942122 DOI: 10.2165/00019053-200624090-00005] [Citation(s) in RCA: 181] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The number of cost-of-illness (COI) studies has expanded considerably over time. One outcome of this growth is that the reported COI estimates are inconsistent across studies, thereby raising concerns over the validity of the estimates and methods. Several factors have been identified in the literature as reasons for the observed variation in COI estimates. To date, the variation in the methods used to calculate costs has not been examined in great detail even though the variations in methods are a major driver of variation in COI estimates. The objective of this review was to document the variation in the methodologies employed in COI studies and to highlight the benefits and limitations of these methods. The review of COI studies was implemented following a four-step procedure: (i) a structured literature search of MEDLINE, JSTOR and EconLit; (ii) a review of abstracts using pre-defined inclusion and exclusion criteria; (iii) a full-text review using pre-defined inclusion and exclusion criteria; and (iv) classification of articles according to the methods used to calculate costs. This review identified four COI estimation methods (Sum_All Medical, Sum_Diagnosis Specific, Matched Control and Regression) that were used in categorising articles. Also, six components of direct medical costs and five components of indirect/non-medical costs were identified and used in categorising articles.365 full-length articles were reflected in the current review following the structured literature search. The top five cost components were emergency room/inpatient hospital costs, outpatient physician costs, drug costs, productivity losses and laboratory costs. The dominant method, Sum_Diagnosis Specific, was a total costing approach that restricted the summation of medical expenditures to those related to a diagnosis of the disease of interest. There was considerable variation in the methods used within disease subcategories. In several disease subcategories (e.g. asthma, dementia, diabetes mellitus), all four estimation methods were represented, and in other cases (e.g. HIV/AIDS, obesity, stroke, urinary incontinence, schizophrenia), three of the four estimation methods were represented. There was also evidence to suggest that the strengths and weaknesses of each method were considered when applying a method to a specific illness. Comparisons and assessments of COI estimates should consider the method used to estimate costs both as an important source of variation in the reported COI estimates and as a marker of the reliability of the COI estimate.
Collapse
Affiliation(s)
- Ebere Akobundu
- Pharmaceutical Health Services Research Department, School of Pharmacy, University of Maryland, Baltimore, Maryland 21201, USA.
| | | | | | | |
Collapse
|
26
|
Goeree R, Farahati F, Burke N, Blackhouse G, O'Reilly D, Pyne J, Tarride JE. The economic burden of schizophrenia in Canada in 2004. Curr Med Res Opin 2005; 21:2017-28. [PMID: 16368053 DOI: 10.1185/030079905x75087] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To estimate the financial burden of schizophrenia in Canada in 2004. METHODS A prevalence-based cost-of-illness (COI) approach was used. The primary sources of information for the study included a review of the published literature, a review of published reports and documents, secondary analysis of administrative datasets, and information collected directly from various federal and provincial government programs and services. The literature review included publications up to April 2005 reported in MedLine, EMBASE and PsychINFO. Where specific information from a province was not available, the method of mean substitution from other provinces was used. Costs incurred by various levels/departments of government were separated into healthcare and non-healthcare costs. Also included in the analysis was the value of lost productivity for premature mortality and morbidity associated with schizophrenia. Sensitivity analysis was used to test major cost assumptions used in the analysis. Where possible, all resource utilization estimates for the financial burden of schizophrenia were obtained for 2004 and are expressed in 2004 Canadian dollars (CAN dollars). RESULTS The estimated number of persons with schizophrenia in Canada in 2004 was 234 305 (95% CI, 136 201-333 402). The direct healthcare and non-healthcare costs were estimated to be 2.02 billion CAN dollars in 2004. There were 374 deaths attributed to schizophrenia. This combined with the high unemployment rate due to schizophrenia resulted in an additional productivity morbidity and mortality loss estimate of 4.83 billion CAN dollars, for a total cost estimate in 2004 of 6.85 billion CAN dollars. By far the largest component of the total cost estimate was for productivity losses associated with morbidity in schizophrenia (70% of total costs) and the results showed that total cost estimates were most sensitive to alternative assumptions regarding the additional unemployment due to schizophrenia in Canada. CONCLUSIONS Despite significant improvements in the past decade in pharmacotherapy, programs and services available for patients with schizophrenia, the economic burden of schizophrenia in Canada remains high. The most significant factor affecting the cost of schizophrenia in Canada is lost productivity due to morbidity. Programs targeted at improving patient symptoms and functioning to increase workforce participation has the potential to make a significant contribution in reducing the cost of this severe mental illness in Canada.
Collapse
Affiliation(s)
- R Goeree
- Program for Assessment of Technology in Health, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.
| | | | | | | | | | | | | |
Collapse
|
27
|
Affiliation(s)
- Sandeep Grover
- Senior Resident, Department of Psychiatry, PGIMER, Chandigarh
| | | | | | | |
Collapse
|
28
|
Grover S, Avasthi A, Chakrabarti S, Bhansali A, Kulhara P. Cost of care of schizophrenia: a study of Indian out-patient attenders. Acta Psychiatr Scand 2005; 112:54-63. [PMID: 15952946 DOI: 10.1111/j.1600-0447.2005.00512.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess the cost of care of Indian out-patients with schizophrenia. METHOD Cost of illness in 50 out-patients with schizophrenia was assessed over a 6-month period together with structured assessments of psychopathology and disability, and compared with 50 out-patients with diabetes mellitus. RESULTS Total annual costs of care of schizophrenia were 274 US dollars; these were not significantly different from diabetes mellitus. Indirect costs (63%) were higher than direct costs. Drug costs were high. The main brunt of financial burden was borne by the family. Total treatment costs in schizophrenia were significantly higher in those who were unemployed, those who visited the hospital more often, and were more severely ill and disabled. CONCLUSION Schizophrenia is an expensive illness to treat even in developing countries. Costs of care are similar to those of chronic physical illness, such as diabetes mellitus. Costs are higher in severely ill and disabled patients.
Collapse
Affiliation(s)
- S Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | | | |
Collapse
|
29
|
Kutcher S, Brooks SJ, Gardner DM, Honer B, Kopala L, Labelle A, Lalonde P, Malla A, Milliken H, Soni J, Williams R. Expert Canadian consensus suggestions on the rational, clinical use of ziprasidone in the treatment of schizophrenia and related psychotic disorders. Neuropsychiatr Dis Treat 2005; 1:89-108. [PMID: 18568067 PMCID: PMC2413202 DOI: 10.2147/nedt.1.2.89.61042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Many atypical antipsychotic medications are becoming available for clinical use. Ziprasidone is a recent addition to this group and is expected to become available for clinical use in Canada in 2005. Ziprasidone has some significant differences compared with other atypicals currently available in Canada. Clinicians need to understand the benefits and risks associated with each of the antipsychotic medications available for the treatment of schizophrenia and related psychotic disorders to ensure their most appropriate utilization. At the suggestion of Professor Stan Kutcher (chair) and as part of an ongoing commitment to provide independent education pertaining to the utility of new psychotropic compounds to health professionals, a panel of Canadian experts in the treatment of schizophrenia spectrum disorders was convened to provide consensus suggestions for the appropriate clinical use of ziprasidone. The consultations regarding the development of these recommendations were organized by Brainworks International (BWI) with arms-length funding from Pfizer Canada. This paper describes the experts' consensus views on the efficacy and safety of ziprasidone, their suggestions on which patients may be suitable for ziprasidone treatment, and how to initiate treatment (including how to switch from other antipsychotic medications), manage side effects, and monitor patients in long-term therapy. These suggestions are those of the authors only and are not endorsed by or necessarily reflect the opinions of BWI or Pfizer Canada.
Collapse
Affiliation(s)
- Stan Kutcher
- Department of Psychiatry Dalhousie University Halifax, NS,
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Block R, Slomp M, Jacobs P, Ohinmaa A. The direct public-sector costs for mental health in Alberta. Healthc Manage Forum 2005; 18:25-8. [PMID: 16323466 DOI: 10.1016/s0840-4704(10)60365-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The purpose of the study was to estimate the direct 2002 fiscal year costs for mental health, services in Alberta. Data were collected on mental health publicly funded services and costs. Mental health services cost $573 million annually, amounting to about 8.4% of all provincial health services. The greatest share of costs was for regional inpatient services and physician services (both at 22%). The more direct method used in this study shows higher estimates of mental health costs than previous studies.
Collapse
|
31
|
Moisan J, Grégoire JP, Gaudet M, Cooper D. Exploring the risk of diabetes mellitus and dyslipidemia among ambulatory users of atypical antipsychotics: a population-based comparison of risperidone and olanzapine. Pharmacoepidemiol Drug Saf 2005; 14:427-36. [PMID: 15786513 DOI: 10.1002/pds.1093] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare the incidence rates of diabetes mellitus and dyslipidemia in ambulatory first-time users of risperidone and olanzapine. METHODS The database for the Prescription Drug Insurance Plan in the province of Quebec was used as the data source for a population-based cohort study. Denominalized data were extracted for all ambulatory patients who first received an atypical antipsychotic between 1 January 1997 and 31 August 1999. Eligible patients were categorized as taking: no antidiabetic medication; no lipid reducing medication; neither type of medication. Those who started to use an outcome drug (an antidiabetic or lipid-lowering medication) before the end of the follow-up period (31 August 2000) were considered to have developed the corresponding outcome disease. Incidence rate ratios (IRR) (and 95% confidence intervals) for initiating antihyperglycemic or lipid-lowering drug treatment, or both were calculated. Outcomes on risperidone were compared to those on olanzapine. RESULTS A total of 19 582 eligible patients were included in the analysis. Relative to risperidone, olanzapine was associated with a higher risk of initiating a pharmacologic treatment for diabetes [IRR: 1.33 (1.03-1.74)], dyslipidemia [IRR: 1.49 (1.22-1.83)], or either condition [1.47 (1.23-1.76)]. CONCLUSIONS Olanzapine seems to be associated with a higher risk of developing diabetes and/or dyslipidemia than risperidone. Further prospective studies are needed to rigorously assess the safety of olanzapine.
Collapse
|
32
|
López-Bastida J, Serrano-Aguilar P, Duque-González B. [Socio-economic costs of mental health in the Canary Islands, Spain, in 2002]. Aten Primaria 2004; 34:32-7. [PMID: 15207197 PMCID: PMC7688693 DOI: 10.1016/s0212-6567(04)79448-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To evaluate the economic impact in terms of direct and indirect costs of the mental health in Canary Islands (Spain) in 2002. DESIGN The cost-of-illness method was used. Direct and indirect costs were estimated using prevalence cost, i.e., the costs produced in 2002. The human capital theory approach has been used. SETTING Canary Islands, Spain, including primary health care and inpatient care. PARTICIPANTS Mental health patients. MAIN MEASUREMENTS Direct health costs (inpatients, ambulatory care, primary health care, and drugs). Indirect costs (premature death, short-term illness, and permanent disability). RESULTS The total costs of mental health were 189.59 million euros. The direct health costs were 81.67 million euros, constituting 43% of the total costs and 5.2% of the total public health care budget in this region. The indirect costs of mental health were 107.92 million euros, representing 57% of the total costs. CONCLUSIONS Although this study adopts a conservative approach, the high socio-economic cost of the mental health helps us to define better the dimension of the problem to establish priorities besides opening a way towards cost-effectiveness studies that allow a more transparent debate on this topic.
Collapse
Affiliation(s)
- J López-Bastida
- Servicio de Evaluación y Planificación, Servicio Canario de Salud, Santa Cruz de Tenerife, Spain.
| | | | | |
Collapse
|
33
|
|
34
|
Noda F, Clark C, Terada H, Hayashi N, Maeda K, Sato M, Ito K, Kitanaka J, Asai T, Nishimura T, Kushigami K, Okada K, Taniguchi Y, Mantani T. Community discharge of patients with schizophrenia: a Japanese experience. Psychiatr Rehabil J 2004; 28:143-9. [PMID: 15605750 DOI: 10.2975/28.2004.143.149] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In Japan, admission to a psychiatric facility for people with schizophrenia is usually for life. We developed a rehabilitation program aimed at discharging these patients into the Tokyo community. This paper describes the results for the 224 patients. Using an inpatient ward at the Tokyo Musashino Hospital, patients were enrolled in the program and subsequently discharged into the community with an assigned worker. The results indicate for the majority (79%) re-integration into the community was successful. The success of this program in a metropolitan city like Tokyo argues for the efficacy of such programs.
Collapse
Affiliation(s)
- Fumitaka Noda
- Department of Human Welfare, Taisho University, Tokyo, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
López-Bastida J, Serrano-Aguilar P, Duque-González B. [Socioeconomic costs of cardiovascular disease and cancer in the Canary Islands (Spain) in 1998]. GACETA SANITARIA 2003; 17:210-7. [PMID: 12841983 DOI: 10.1016/s0213-9111(03)71730-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the economic impact in terms of direct and indirect costs of the cardiovascular disease and cancer in the Canary Islands in 1998. METHODS The cost-of-illness method was used. Direct and indirect costs were estimated using prevalence costs, i.e., the costs produced in 1998. Direct costs were divided into hospitalization costs, outpatient costs, primary health care costs, and drug costs while indirect costs were obtained through transformation of physical units into monetary units using the approach of human capital theory and the friction cost method. RESULTS The total costs of cardiovascular disease and cancer were 246.11 and 193.72 million euros respectively. The direct costs of the two diseases were 134.44 and 58.04 million euros respectively, representing 55% and 30% of total costs and 16% of total health care expenditure in this region. The indirect costs of these two diseases were 111.68 and 135.68 million euros respectively, representing 45% and 70% of total costs. Use of the friction cost method revealed that indirect costs decreased by 88% for cardiovascular disease and those for cancer decreased by 77%. CONCLUSIONS Although this study adopts a conservative approach by omitting costs associated with pain and suffering, permanent disability, and those of at-home care provided by the family, the annual socioeconomic cost of cardiovascular disease and cancer in the Canary Islands was high, amounting to 440 million euros.
Collapse
Affiliation(s)
- J López-Bastida
- Servicio de Evaluación y Planificación. Servicio Canario de Salud, Spain.
| | | | | |
Collapse
|
36
|
Abstract
Schizophrenia is a common and debilitating illness, characterized by chronic psychotic symptoms and psychosocial impairment that exact considerable human and economic costs. The literature in electronic databases as well as citations and major articles are reviewed with respect to the phenomenology, pathology, treatment, genetics and neurobiology of schizophrenia. Although studied extensively from a clinical, psychological, biological and genetic perspective, our expanding knowledge of schizophrenia provides only an incomplete understanding of this complex disorder. Recent advances in neuroscience have allowed the confirmation or refutation of earlier findings in schizophrenia, and permit useful comparisons between the different levels of organization from which the illness has been studied. Schizophrenia is defined as a clinical syndrome that may include a collection of diseases that share a common presentation. Genetic factors are the most important in the etiology of the disease, with unknown environmental factors potentially modulating the expression of symptoms. Schizophrenia is a complex genetic disorder in which many genes may be implicated, with the possibility of gene-gene interactions and a diversity of genetic causes in different families or populations. A neurodevelopmental rather than degenerative process has received more empirical support as a general explanation of the pathophysiology, although simple dichotomies are not particularly helpful in such a complicated disease. Structural brain changes are present in vivo and post-mortem, with both histopathological and imaging studies in overall agreement that the temporal and frontal lobes of the cerebral cortex are the most affected. Functional imaging, neuropsychological testing and clinical observation are also generally consistent in demonstrating deficits in cognitive ability that correlate with abnormalities in the areas of the brain with structural abnormalities. The dopamine and other neurotransmitter systems are certainly involved in the treatment or modulation of psychotic symptoms. These broad findings represent the distillation of a large body of disparate data, but firm and specific findings are sparse, and much about schizophrenia remains unknown.
Collapse
Affiliation(s)
- Albert Hung Choy Wong
- Centre for Addiction and Mental Health, 250 College Street, M5T 1R8, Toronto, Ont., Canada.
| | | |
Collapse
|
37
|
Carr VJ, Neil AL, Halpin SA, Holmes S, Lewin TJ. Costs of schizophrenia and other psychoses in urban Australia: findings from the Low Prevalence (Psychotic) Disorders Study. Aust N Z J Psychiatry 2003; 37:31-40. [PMID: 12534654 DOI: 10.1046/j.1440-1614.2003.01092.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To estimate the costs associated with the treatment and care of persons with psychosis in Australia based on data from the Low Prevalence Disorders Study (LPDS), and to identify areas where there is potential for more efficient use of existing health care resources. METHOD The LPDS was a one-month census-based survey of people with psychotic disorders in contact with mental health services, which was conducted in four metropolitan regions in 1997-1998. Mental health and service utilization data from 980 interviews were used to estimate the economic costs associated with psychotic disorders. A prevalence-based, 'bottom-up' approach was adopted to calculate the government and societal costs associated with psychosis, including treatment and non-treatment related costs. RESULTS Annual societal costs for the average patient with psychosis are of the order of 46,200 Australian dollars , comprising 27,500 Australian dollars in lost productivity, 13,800 Australian dollars in inpatient mental health care costs and 4900 Australian dollars in other mental health and community services costs. Psychosis costs the Australian government at least 1.45 billion Australian dollars per annum, while societal costs are at least 2.25 billion Australian dollars per annum (including 1.44 billion Australian dollars for schizophrenia). We also report relationships between societal costs and demographic factors, diagnosis, disability and participation in employment. CONCLUSIONS Current expenditure on psychosis in Australia is probably inefficient. There may be substantial opportunity costs in not delivering effective treatments in sufficient volume to people with psychotic disorders, not intervening early, and not improving access to rehabilitation and supported accommodation.
Collapse
Affiliation(s)
- Vaughan J Carr
- Centre for Mental Health Studies, University of Newcastle, Callaghan, NSW, Australia.
| | | | | | | | | |
Collapse
|
38
|
Abstract
OBJECTIVE This commentary reviews current expenditure on psychosis in Australia, identifies discretionary expenditure that could be used more efficiently, discusses the factors influencing resource allocation and intervention selection decisions, and suggests priorities for change. METHOD Cost-of-illness findings from the Low Prevalence Disorders Study (LPDS), and related service use and psychosocial data, are used to highlight patterns of expenditure on psychosis and potential resource allocation issues. Arguments are also presented suggesting that mental health resource allocation in Australia should be informed primarily by treatment efficiency, equity and humanitarian considerations, not differences in the global burden of disease. However, our evidence-base about the effectiveness and costs associated with individual treatments, programmes, and organizational structures is also shown to be limited. CONCLUSIONS The patterns of service use and expenditure on psychosis suggest certain imbalances, including an over-reliance on hospitalization, low levels of supported community accommodation, and inadequate provision of evidence-based psychosocial treatments, rehabilitation and supported employment programmes. We need to identify and develop efficient interventions and programmes, re-orientate our services to better utilize those interventions, increase community awareness, improve monitoring of outcomes and costs, and undertake timely evaluations at multiple levels, from the individual to the societal perspective.
Collapse
Affiliation(s)
- Amanda L Neil
- Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Callaghan, New South Wales, Australia
| | | | | |
Collapse
|
39
|
Tilden D, Aristides M, Meddis D, Burns T. An economic assessment of quetiapine and haloperidol in patients with schizophrenia only partially responsive to conventional antipsychotics. Clin Ther 2002; 24:1648-67. [PMID: 12462294 DOI: 10.1016/s0149-2918(02)80069-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Many patients with schizophrenia exhibit only a partial response to conventional antipsychotic agents, making them difficult to treat adequately. OBJECTIVE This analysis models the cost-effectiveness of quetiapine compared with haloperidol in partial responders with schizophrenia. METHODS Outcome data from the Partial Responders International schiZophrenia Evaluation (PRIZE) clinical trial comparing quetiapine and haloperidol in partial responders with schizophrenia as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition were combined with data from the literature to construct a Markov model. The model was used to calculate treatment outcomes and total direct treatment costs from the perspective of the United Kingdom National Health Service over 5 years. RESULTS The PRIZE study showed that quetiapine treatment resulted in a higher response rate and better tolerability than haloperidol treatment. These benefits have the potential to improve compliance and reduce relapse rates. The model showed that the higher acquisition cost of quetiapine was offset by lower costs for other medications, hospitalization, and other medical services. The total treatment cost over 5 years was 38,106 pounds for quetiapine and 38,350 pounds for haloperidol, a cost saving of 244 pounds in favor of quetiapine. Quetiapine-treated patients also spent longer in response states and experienced fewer relapses. Sensitivity analysis showed these results to be robust across a range of conditions. CONCLUSIONS Quetiapine has the potential to improve outcomes compared with haloperidol in partial responders with schizophrenia, at a slightly lower total cost. The higher acquisition cost of quetiapine was offset by savings in other medical costs. Quetiapine could significantly improve the management of this patient group, without increasing the economic burden on the health service.
Collapse
Affiliation(s)
- Dominic Tilden
- Medical Technology Assessment Group, Ltd, London, United Kingdom
| | | | | | | |
Collapse
|
40
|
Dewa CS, Remington G, Herrmann N, Fearnley J, Goering P. How much are atypical antipsychotic agents being used, and do they reach the populations who need them? A Canadian experience. Clin Ther 2002; 24:1466-76. [PMID: 12380638 DOI: 10.1016/s0149-2918(02)80050-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The introduction of new antipsychotic agents in the past decade has helped alter the treatments available to 2 vulnerable populations-those with schizophrenia and related psychotic conditions and elderly individuals with dementia. OBJECTIVE After examining overall trends in antipsychotic use, this analysis reviews patterns of atypical antipsychotic use in the elderly and financially disadvantaged populations of Ontario. It identifies affected subpopulations and offers several interpretations of how observed patterns of use reflect outpatient prescribing practices. METHODS This study used drug claims data from the Ontario Drug Benefit (ODB) program for the years 1992 to 1998. The use of antipsychotic agents was followed for 2 years in a subpopulation of ODB participants identified as consistent users of these agents (ie, those with evidence of > 1-time use). RESULTS During the study period, the total number of ODB claimants grew by 1%, the number of claimants using antipsychotic agents increased by approximately 25%, and the expenditure per claimant in this group increased by nearly 250%. Much of this growth in expenditures was associated with use of the newer atypical antipsychotic agents olanzapine, risperidone, and quetiapine. Compared with patients aged > or = 65 years, those aged < 65 years were more likely to receive an initial prescription for an atypical antipsychotic or be switched to an atypical antipsychotic. However, the proportion of patients aged > 85 years consistently using antipsychotic agents was greater than predicted based on the proportion of the ODB population they represent. These patients were more likely to use conventional antipsychotic agents exclusively. CONCLUSIONS The introduction of the atypical antipsychotic agents was paralleled by a striking increase in ODB expenditures for antipsychotic drugs, although use of these agents was not consistent across age groups. There was more switching to atypical antipsychotics, as well as greater use in general, among younger compared with older patients, despite evidence that the atypical antipsychotics may be safer in the elderly than conventional antipsychotics. Guideline dissemination may be an important way of familiarizing clinicians with the atypical agents. Health care systems should be aware of the potential for a substantial increase in health care costs with more widespread adoption of these medications.
Collapse
Affiliation(s)
- Carolyn S Dewa
- Health Systems Research and Consulting Unit, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| | | | | | | | | |
Collapse
|
41
|
López Bastida J, Serrano Aguilar P, Duque González B. [The social and economic cost of diabetes mellitus]. Aten Primaria 2002; 29:145-50. [PMID: 11879600 PMCID: PMC7684131 DOI: 10.1016/s0212-6567(02)70526-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate the economic impact in terms of the direct costs (health care costs) and the indirect costs (effects on production caused by mortality and morbidity) of diabetes mellitus (DM) in the Canary Islands (Spain) during 1998. DESIGN The approach used was to study the cost of the disease through looking only at people in the productive sphere (human capital). Direct and indirect costs were calculated by using costs of prevalence, i.e. the costs caused during 1998. SETTING Direct costs were broken down into hospital care, primary care, out-patient consultations, drugs and further tests; indirect costs, into premature mortality and time off work. Measurements and main results. The total cost of DM amounted to 6468.76 million pesetas (38.88 millio ), or the equivalent of 126 168 pesetas (758.28 ) a year for each known diabetic patient. Total direct cost of DM was 4011.51 million pesetas (24.11 million ), which amounts to 2.13% of health expenditure in the Canaries; or the equivalent of 78 240 pesetas (470.23 ) a year for each known diabetic patient. Direct cost of health care was 62% of the total cost. Total indirect cost was 2457.25 million pesetas (14.77 million ), 38% of the total cost. CONCLUSIONS Despite the conservatism of the approach, in that the study omitted costs linked to pain and suffering, permanent disability or home care by family members, the high social and economic cost of DM patients calls for cost-effectiveness studies that would permit a more transparent debate on this question.
Collapse
Affiliation(s)
- J López Bastida
- Servicio del Plan de Salud, Investigación y Evaluación de Tecnologías. Servicio Canario de Salud. Santa Cruz de Tenerife. Spain.
| | | | | |
Collapse
|
42
|
López J, Serrano P, Duque B, Artiles J. [Socio-economic costs of road traffic accidents in the Canary Islands, Spain, in 1997]. GACETA SANITARIA 2001; 15:414-22. [PMID: 11734154 DOI: 10.1016/s0213-9111(01)71595-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the economic impact in terms of direct and indirect costs road traffic accidents in Canarias Islands (Spain) in 1997. METHOD The cost-of-illness method was used. Direct and indirect costs were estimated using prevalence cost, i.e., the costs produced in 1997. Direct costs were divided into health services costs, insurance administration costs and the costs of material damage to the vehicles. Indirect costs were obtained through transformation of physical units into monetary units using the approach of human capital theory. RESULTS The total cost of road traffic accidents was 39,887.16 million pesetas, equivalent to 24,470 for each inhabitant of the Canary Islands and representing 1.3% of the GNP in this region. The total direct cost was 32,559.67 million pesetas, constituting 82% of the total, which was distributed according to the different concepts analyzed: health service costs: 2,407.40 million pesetas; insurance administration costs, 13,415.89 million pesetas and the costs of material damages to the vehicles: 16,736.38 million pesetas. The total indirect costs was 7,327.49 million pesetas, accounting for 18% of the total costs, which was distributed in premature mortality (6,884.88 million pesetas) and absenteeism from work (442.61 million pesetas). CONCLUSIONS Although this study adopts a conservative approach by omitting costs associated with pain and suffering, permanent disability, and those of at-home care provided by the family, the hight socio-economic cost of road traffic accidents clearly indicates the need for the different administrations of the Canary Islands to collaborate in implementing preventive measures.
Collapse
Affiliation(s)
- J López
- Servicio del Plan de Salud, Investigación y Evaluación de Tecnologías. Servicio Canario de Salud
| | | | | | | |
Collapse
|
43
|
Marcotte DE, Wilcox-Gök V. Estimating the employment and earnings costs of mental illness: recent developments in the United States. Soc Sci Med 2001; 53:21-7. [PMID: 11386306 DOI: 10.1016/s0277-9536(00)00312-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Substantial attention has recently been focused on both the prevalence and consequences of mental illness. Generally, public interest in the costs of mental illness has been limited to the direct costs of treating the mentally ill. In this paper, we consider the magnitude and importance of a major component of the indirect costs of mental illness: employment and earnings losses. We first describe the technical difficulties involved in estimating these costs. We then describe new data and recent advances in the United States that have improved our ability to make such estimates. Our conclusions from the recent research are that each year in the United States 5-6 million workers between the ages of 16 and 54 lose, fail to seek, or cannot find employment as a consequence of mental illness. Among those who do work, we estimate that mental illness decreases annual income by an amount between $3,500 and $6,000. We then discuss an emerging challenge to the traditional method for arriving at such estimates: the friction cost approach. We describe both the conceptual and technical differences between the friction cost method and the traditional human capital approach. We conclude that while economic context has much to do with whether one relies on human capital or friction cost estimates, each can offer useful information about labor market losses due to mental illness.
Collapse
Affiliation(s)
- D E Marcotte
- Policy Sciences Graduate Program, University of Maryland Baltimore County, Baltimore 21250, USA.
| | | |
Collapse
|
44
|
Frangou S, Byrne P. How to manage the first episode of schizophrenia. BMJ (CLINICAL RESEARCH ED.) 2000; 321:522-3. [PMID: 10968798 PMCID: PMC1118427 DOI: 10.1136/bmj.321.7260.522] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
45
|
Snaterse M, Welch R. A Retrospective, Naturalistic Review Comparing Clinical Outcomes of In-Hospital Treatment with Risperidone and Olanzapine. Clin Drug Investig 2000. [DOI: 10.2165/00044011-200020030-00003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|