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Sato S, Nakanishi M, Ogawa M, Abe M, Yasuma N, Kono T, Igarashi M, Iwanaga M, Kawaguchi T, Yamaguchi S. Rehospitalisation rates after long-term follow-up of patients with severe mental illness admitted for more than one year: a systematic review. BMC Psychiatry 2023; 23:788. [PMID: 37891519 PMCID: PMC10612306 DOI: 10.1186/s12888-023-05290-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
AIMS This study aimed to conduct a systematic review of studies on the outcomes of long-term hospitalisation of individuals with severe mental illness, considering readmission rates as the primary outcome. METHODS Studies considered were those in which participants were aged between 18 and 64 years with severe mental illness; exposure to psychiatric hospitals or wards was long-term (more than one year); primary outcomes were readmission rates; secondary outcomes were duration of readmission, employment, schooling, and social participation; and the study design was either observational or interventional with a randomised controlled trial (RCT) design. Relevant studies were searched using MEDLINE, PsycINFO, Web of Science, CINAHL, and the Japan Medical Abstract Society. The final search was conducted on 1 February 2022. The risk of bias in non-randomised studies of interventions was used to assess the methodological quality. A descriptive literature review is also conducted. RESULTS Of the 11,999 studies initially searched, three cohort studies (2,293 participants) met the eligibility criteria. The risk of bias in these studies was rated as critical or serious. The 1-10 years readmission rate for patients with schizophrenia who had been hospitalised for more than one year ranged from 33 to 55%. The average of readmission durations described in the two studies was 70.5 ± 95.6 days per year (in the case of a 7.5-year follow-up) and 306 ± 399 days (in the case of a 3-8-year follow-up). None of the studies reported other outcomes defined in this study. CONCLUSIONS The readmission rates in the included studies varied. Differences in the follow-up period or the intensity of community services may have contributed to this variability. In countries preparing to implement de-institutionalisation, highly individualised community support should be designed to avoid relocation to residential services under supervision. The length of stay for readmissions was shorter than that for index admissions. The results also imply that discharge to the community contributes to improved clinical outcomes such as improved social functioning. The validity of retaining patients admitted because of the risk of rehospitalisation was considered low. Future research directions have also been discussed.
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Affiliation(s)
- Sayaka Sato
- Department of Community Mental Health & Law, National Center of Neurology and Psychiatry (NCNP), National Institute of Mental Health, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan.
| | - Miharu Nakanishi
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Makoto Ogawa
- Department of Community Mental Health & Law, National Center of Neurology and Psychiatry (NCNP), National Institute of Mental Health, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
| | - Makiko Abe
- Department of Community Mental Health & Law, National Center of Neurology and Psychiatry (NCNP), National Institute of Mental Health, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
| | - Naonori Yasuma
- Department of Community Mental Health & Law, National Center of Neurology and Psychiatry (NCNP), National Institute of Mental Health, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
| | - Toshiaki Kono
- Department of Community Mental Health & Law, National Center of Neurology and Psychiatry (NCNP), National Institute of Mental Health, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
| | - Momoka Igarashi
- Department of Community Mental Health & Law, National Center of Neurology and Psychiatry (NCNP), National Institute of Mental Health, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
| | - Mai Iwanaga
- Department of Community Mental Health & Law, National Center of Neurology and Psychiatry (NCNP), National Institute of Mental Health, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
| | - Takayuki Kawaguchi
- Department of Community Mental Health & Law, National Center of Neurology and Psychiatry (NCNP), National Institute of Mental Health, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
| | - Sosei Yamaguchi
- Department of Community Mental Health & Law, National Center of Neurology and Psychiatry (NCNP), National Institute of Mental Health, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
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Li J, Du H, Dou F, Yang C, Zhao Y, Ma Z, Hu X. A study on the changing trend and influencing factors of hospitalization costs of schizophrenia in economically underdeveloped areas of China. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:4. [PMID: 36658140 PMCID: PMC9852576 DOI: 10.1038/s41537-023-00331-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/06/2023] [Indexed: 01/20/2023]
Abstract
The public health problems caused by schizophrenia are becoming increasingly prominent and can place a huge economic burden on society. This study takes Gansu Province as an example to analyze the level and changing trend of the economic burden of schizophrenia inpatients in economically underdeveloped areas of China. Using a multi-stage stratified cluster sampling method, 39,054 schizophrenics from 197 medical and health institutions in Gansu Province were selected as the research objects, and their medical expenses and related medical records were obtained from the medical information system. The rank sum test and Spearman rank correlation were used for univariate analysis. Quantile regression and random forest were used to analyze the influencing factors. The results show that the average length of stay of schizophrenics in Gansu Province of China was 52.01 days, and the average hospitalization cost was USD1653.96 from 2014 to 2019. During the six years, the average hospitalization costs per time decreased from USD2136.85 to USD1401.33. The average out-of-pocket costs per time decreased from USD1238.78 to USD267.68. And the average daily hospitalization costs increased from USD38.18 to USD41.25. The main factors influencing hospitalization costs are length of stay, proportion of medications, and schizophrenic subtype. The hospitalization costs per time of schizophrenics in Gansu Province have decreased but remain at a high level compared to some other chronic non-communicable diseases. In the future, attention should be paid to improving the efficiency of medical institutions, enhancing community management, and promoting the transformation of the management model of schizophrenia.
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Affiliation(s)
- Jianjian Li
- grid.32566.340000 0000 8571 0482Department of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, 730000 Lanzhou, Gansu Province China
| | - Hongmei Du
- grid.32566.340000 0000 8571 0482Department of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, 730000 Lanzhou, Gansu Province China
| | - Feng Dou
- grid.32566.340000 0000 8571 0482Department of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, 730000 Lanzhou, Gansu Province China
| | - Chao Yang
- grid.32566.340000 0000 8571 0482Department of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, 730000 Lanzhou, Gansu Province China
| | - Yini Zhao
- grid.32566.340000 0000 8571 0482Department of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, 730000 Lanzhou, Gansu Province China
| | - Zhibin Ma
- grid.32566.340000 0000 8571 0482Department of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, 730000 Lanzhou, Gansu Province China
| | - Xiaobin Hu
- grid.32566.340000 0000 8571 0482Department of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, 730000 Lanzhou, Gansu Province China
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Ding R, He P, Zheng X. Socioeconomic inequality in rehabilitation service utilization for schizophrenia in China: Findings from a 7-year nationwide longitudinal study. Front Psychiatry 2022; 13:914245. [PMID: 36090373 PMCID: PMC9459142 DOI: 10.3389/fpsyt.2022.914245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Few studies have focused on the utilization of rehabilitation services among people with schizophrenia. In this study, we aimed to examine the trend of pharmacological and psychotherapy service utilization among adults with schizophrenia and to identify the associated socioeconomic factors. METHODS Data were obtained from the Second National Sample Survey on Disability in 2006 and from the follow-up investigation in 2007-2013. Individuals with schizophrenia were ascertained by the combination of self-reports and on-site diagnosis by psychiatrists. Random effect logistic regression models were applied to examine the socioeconomic disparity in service utilization and the time trend in the association. RESULTS Overall, the percentage of individuals using pharmacological treatment services increased from 23.7 in 2007 to 55.0% in 2013, and the percentage of individuals using psychotherapy services increased from 11.4 to 39.4%. Living in rural areas, being illiterate, living in families with lower income and being uninsured were less likely to receive pharmacological treatment and psychotherapy. The pace of growth in service utilization was higher among individuals with rural residence, illiteracy or low-income status than among their counterparts with advantaged backgrounds. CONCLUSIONS This study demonstrated an upward trend in pharmacological treatment and psychotherapy service utilization and a downward trend in socioeconomic disparity among Chinese adults with schizophrenia. Future studies to explore the reasons for the observed changes and to identify policies for improving the health service access of this vulnerable group are warranted.
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Affiliation(s)
- Ruoxi Ding
- China Center for Health and Development Studies, Peking University, Beijing, China
| | - Ping He
- China Center for Health and Development Studies, Peking University, Beijing, China
| | - Xiaoying Zheng
- Asia Pacific Economic Cooperation Health Sciences Academy, Peking University, Beijing, China
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Yi ZM, Men P, Qu S, Li C, Yu X, Zhai S. Comparative cost-effectiveness of amisulpride and olanzapine in the treatment of schizophrenia in China. Expert Rev Pharmacoecon Outcomes Res 2020; 20:313-320. [PMID: 32293194 DOI: 10.1080/14737167.2020.1752670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Both amisulpride and olanzapine are leading treatments for schizophrenia in China. This study aimed to investigate the long-term cost-effectiveness of amisulpride and olanzapine in the treatment of schizophrenia in China. METHODS A decision-analytic Markov model was developed to simulate the lifetime clinical and economic outcomes of schizophrenia treatment from the healthcare payer perspective. The long-term costs and QALYs were estimated. Sensitivity analyses were performed to explore the impact of variance of parameters on the results. RESULTS Treatment with amisulpride provided an effectiveness gain of 16.59 QALYs at an average cost of USD 25,884 whereas olanzapine resulted in 16.38 QALYs at a cost of USD 34,839 over a lifetime horizon. One-way sensitivity analysis suggested that the most sensitive variable was the unit cost of olanzapine. In a probabilistic sensitivity analysis based on a Monte Carlo simulation with a lifetime horizon, the probability of amisulpride being cost-effective was 99.8% at a willingness-to-pay threshold of USD 9,322, the GDP per capita in China 2018. A scenario analysis with updated olanzapine unit cost suggested an ICER of 7,857 USD/QALY. CONCLUSIONS Amisulpride is likely to be a cost-effective option with increased effectiveness compared with olanzapine in the treatment of schizophrenia patients in China.
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Affiliation(s)
- Zhan-Miao Yi
- Department of Pharmacy, Peking University Third Hospital , Beijing, China.,Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Science, Peking University , Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center , Beijing, China
| | - Peng Men
- Department of Pharmacy, Peking University Third Hospital , Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center , Beijing, China
| | - Shuli Qu
- Real-World Insights, IQVIA , Shanghai, China
| | - Chaoyun Li
- Health Economics & Outcome Research, Sanofi , Shanghai, China
| | - Xin Yu
- Department of Psychiatry, Peking University Sixth Hospital , Beijing, China
| | - Suodi Zhai
- Department of Pharmacy, Peking University Third Hospital , Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center , Beijing, China
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Puspitasari IM, Sinuraya RK, Rahayu C, Witriani W, Zannah U, Hafifah A, Ningtyas AR, Vildayanti H. Medication Profile and Treatment Cost Estimation Among Outpatients with Schizophrenia, Bipolar Disorder, Depression, and Anxiety Disorders in Indonesia. Neuropsychiatr Dis Treat 2020; 16:815-828. [PMID: 32273708 PMCID: PMC7105358 DOI: 10.2147/ndt.s240058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/10/2020] [Indexed: 12/16/2022] Open
Abstract
PURPOSE The present retrospective study aimed to determine the medication profile and estimate the treatment costs from medical records of new outpatients with schizophrenia, bipolar disorder, depression, and anxiety disorders from a healthcare perspective at a national referral hospital in Indonesia from 2016 to 2018. METHODS Medical records (including medical and administrative data) of 357 new outpatients with schizophrenia, bipolar disorder, depression, or anxiety disorders were collected from the hospital information system. The records of new outpatients with schizophrenia, bipolar disorder, depression, or anxiety disorders aged >18 years and had only received drugs for treatment were included. The medication profile was descriptively assessed, and estimated costs were calculated based on direct costs from a healthcare perspective. RESULTS Overall, 173 medical records were further analyzed. The main drugs administered to the new outpatients were atypical and typical antipsychotics for schizophrenia, atypical antipsychotics and mood stabilizers for bipolar disorder, antidepressants and atypical antipsychotics for depression, and antidepressants and benzodiazepines for anxiety disorders. The average annual treatment costs per patient were IDR 3,307,931 (USD 236) for schizophrenia, IDR 17,978,865 (USD 1,284) for bipolar disorder, IDR 1,601,850 (USD 114) for depression, and IDR 1,190,563 (USD 85) for anxiety disorders. CONCLUSION The most commonly prescribed drugs for schizophrenia were haloperidol and risperidone; for bipolar disorders, sodium divalproex and risperidone; for depression, fluoxetine and sertraline; and for anxiety disorders, sertraline and lorazepam. Considering the high prevalence and estimated treatment costs for mental disorders, special attention is required to prevent an increase in their prevalence in Indonesia.
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Affiliation(s)
- Irma M Puspitasari
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Rano K Sinuraya
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia
| | | | - Witriani Witriani
- Faculty of Psychology, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Uzlifatul Zannah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Auliani Hafifah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Ajeng R Ningtyas
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Hilda Vildayanti
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
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Zhao J, Jiang K, Li Q, Zhang Y, Cheng Y, Lin Z, Xuan J. Cost-effectiveness of olanzapine in the first-line treatment of schizophrenia in China. J Med Econ 2019; 22:439-446. [PMID: 30732487 DOI: 10.1080/13696998.2019.1580714] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES This study aimed to analyze (1) the cost-effectiveness of olanzapine orally disintegrating tablet (ODT) compared to olanzapine standard oral tablet (SOT) and (2) the cost-effectiveness of olanzapine-SOT compared to aripiprazole-SOT for patients with schizophrenia in China. METHODS A microsimulation model was adapted from a healthcare payers' perspective. The model ran over a 1-year time horizon, using quarterly cycles. The costs of adverse events were acquired through a clinical expert panel. The average bidding prices in China of olanzapine-ODT, olanzapine-SOT, aripiprazole-SOT, and other switch alternatives were used. Inpatient and outpatient medical costs were sourced from the Urban Employee Basic Medical Insurance database in Tianjin. Additionally, adherence, efficacy, safety, and utility data were taken from the literature. Uncertainty of parameters were assessed through one-way and probabilistic sensitivity analyses. RESULTS The total annual costs per patient in aripiprazole-SOT arm, olanzapine-SOT arm, and olanzapine-ODT arm are USD 2,296.05, USD 1,940.05, and USD 2,292.81, respectively. The average number of relapses per patient in 1 year in the aripiprazole-SOT arm, olanzapine-SOT arm, and olanzapine-ODT arm, are 0.734, 0.325, and 0.198, respectively. The quality-adjusted life years (QALYs) gained per patient in 1 year in the aripiprazole-SOT arm, olanzapine-SOT arm, and olanzapine-ODT arm are 0.714, 0.737, and 0.758, respectively. Consequently, (1) the incremental cost-effectiveness ratios (ICERs) of administrating olanzapine-ODT over olanzapine-SOT are USD 2,791.96 per relapse avoided and USD 16,798.39 per QALY gained; and (2) the ICERs of using olanzapine-SOT over aripiprazole-SOT are USD -870.39 per relapse avoided and USD -15,477.93 per QALY gained. All ICERs are under the willingness-to-pay threshold in China of USD 25,772.67. The sensitivity analyses confirmed the robustness of the results. CONCLUSION As the first-line treatment for schizophrenia in China, olanzapine-ODT is cost-effective compared to olanzapine-SOT and olanzapine-SOT is cost-effective compared to aripiprazole-SOT.
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Affiliation(s)
- Jingping Zhao
- a The Second Xiangya Hospital of Central South University , Changsha City , Hunan Province , China
| | - Kaida Jiang
- b Shanghai Mental Health Center , Shanghai , China
| | - Qingwei Li
- c Departemnt of Psychiatry, Tongji Hospital , Tongji University School of Medicine , Shanghai , China
| | - Yanlei Zhang
- d Lilly Suzhou Pharmaceutical Co., Ltd , Shanghai , China
| | - Yan Cheng
- d Lilly Suzhou Pharmaceutical Co., Ltd , Shanghai , China
| | - Ziyi Lin
- e Shanghai Centennial Scientific Co., Ltd , Shanghai , China
| | - Jianwei Xuan
- f Sun Yat-sen University , College Town , Guangzhou , China
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Zhang H, Sun Y, Zhang D, Zhang C, Chen G. Direct medical costs for patients with schizophrenia: a 4-year cohort study from health insurance claims data in Guangzhou city, Southern China. Int J Ment Health Syst 2018; 12:72. [PMID: 30479658 PMCID: PMC6251138 DOI: 10.1186/s13033-018-0251-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/19/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Schizophrenia is one of the leading public health issues in psychiatry and imposes a heavy financial burden on the healthcare systems. This study aims to report the direct medical costs and the associated factors for patients with schizophrenia in Guangzhou city, Southern China. METHODS This was a retrospective 4-year cohort study. Data were obtained from urban health insurance claims databases of Guangzhou city, which contains patients' sociodemographic characteristics, direct medical costs of inpatient and outpatient care. The study cohort (including all the reimbursement claims submitted for schizophrenia inpatient care during November 2010 and October 2014) was identified using the International Classification of Diseases Tenth version (F20). Their outpatient care information was merged from outpatient claims database. Descriptive analysis and the multivariate regression analysis based on Generalized Estimating Equations model were conducted. RESULTS A total of 2971 patients were identified in the baseline. The cohort had a mean age of 50.3 years old, 60.6% were male, and 67.0% received medical treatment in the tertiary hospitals. The average annual length of stay was 254.7 days. The average annual total direct medical costs per patient was 41,972.4 Chinese Yuan (CNY) ($6852.5). The inpatient costs remained as the key component of total medical costs. The Urban Employee Basic Medical Insurance enrollees with schizophrenia had higher average costs for hospitalization (CNY42,375.1) than the Urban Resident Basic Medical Insurance enrollees (CNY40,917.3), and had higher reimbursement rate (85.8% and 61.5%). The non-medication treatment costs accounted for the biggest proportion of inpatient costs for both schemes (55.8% and 64.7%). Regression analysis suggested that insurance type, age, hospital levels, and length of stay were significantly associated with inpatient costs of schizophrenia. CONCLUSIONS The direct annual medical costs of schizophrenia were high and varied by types of insurance in urban China. The findings of this study provide vital information to understand the burden of schizophrenia in China. Results of this study can help decision-makers assess the financial impact of schizophrenia.
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Affiliation(s)
- Hui Zhang
- School of Public Health, Sun Yat-sen University, No. 74, Zhongshan 2nd Road, Guangzhou, China
| | - Yuming Sun
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109 USA
| | - Donglan Zhang
- Department of Health Policy and Management, College of Public Health, University of Georgia, 100 Foster Road, Wright Hall 205D, Athens, GA 30602 USA
| | - Chao Zhang
- Business School, Sun Yat-sen University, No. 135, Xingang Xi Road, Guangzhou, China
| | - Gang Chen
- College of Medicine and Public Health, Flinders University, Adelaide, SA 5041 Australia
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Men P, Yi Z, Li C, Qu S, Xiong T, Yu X, Zhai S. Comparative efficacy and safety between amisulpride and olanzapine in schizophrenia treatment and a cost analysis in China: a systematic review, meta-analysis, and cost-minimization analysis. BMC Psychiatry 2018; 18:286. [PMID: 30185173 PMCID: PMC6125952 DOI: 10.1186/s12888-018-1867-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 08/28/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Amisulpride was introduced into China in 2010 as a second-generation atypical antipsychotic, while olanzapine has been on the market since 1999 as one of the leading treatments for schizophrenia in China. Since more Chinese patients are gaining access to amisulpride, the study aims to compare the efficacy, safety, and costs between amisulpride and olanzapine for schizophrenia treatment in China. METHODS PubMed, Embase, the Cochrane library, China National Knowledge Infrastructure (CNKI) and WanFang database were systematically searched for randomized controlled trials (RCTs) up to July 2018. The Cochrane Risk of Bias tool was utilized to assess the quality of included studies. A meta-analysis was performed to compare the efficacy and safety of amisulpride and olanzapine, followed by a cost-minimization analysis using local drug and medical costs reported in China. RESULTS Twenty RCTs with 2000 patients were included in the systematic review. There were no significant differences between amisulpride and olanzapine on efficacy measures based on scores from the Positive and Negative Syndrome Scale, the Scale for the Assessment of Negative Symptoms, the Brief Psychiatric Rating Scale and the Clinical Global Impressions-Severity or Improvement. For safety outcomes, amisulpride was associated with lower fasting blood glucose and less abnormal liver functions as well as significantly lower risks of weight gain, constipation, and somnolence; olanzapine was associated with significantly lower risks of insomnia and lactation/amenorrhea/sexual hormone disorder. No significant differences were found in risks of extrapyramidal symptoms (EPS), tremor, akathisia, abnormal corrected QT interval. Cost-minimization analysis showed that amisulpride was likely to be a cost-saving alternative in China, with potential savings of 1358 Chinese Yuan (CNY) per patient for a three-month schizophrenia treatment compared with olanzapine. CONCLUSION As the first meta-analysis and cost-minimization analysis comparing the efficacy, safety and cost of amisulpride and olanzapine within a Chinese setting, the study suggests that amisulpride may be an effective, well-tolerated, and cost-saving antipsychotic drug alternative in China.
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Affiliation(s)
- Peng Men
- 0000 0004 0605 3760grid.411642.4Department of Pharmacy, Peking University Third Hospital, N. Huayuan Rd, Beijing, China ,0000 0001 2256 9319grid.11135.37Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China ,0000 0001 2256 9319grid.11135.37Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Science, Peking University, Beijing, China
| | - Zhanmiao Yi
- 0000 0004 0605 3760grid.411642.4Department of Pharmacy, Peking University Third Hospital, N. Huayuan Rd, Beijing, China ,0000 0001 2256 9319grid.11135.37Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China ,0000 0001 2256 9319grid.11135.37Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Science, Peking University, Beijing, China
| | - Chaoyun Li
- 0000 0004 0485 8549grid.476734.5Health Economics & Outcome Research, Sanofi, Yanan Rd, Shanghai, China
| | - Shuli Qu
- Real-World Insights, IQVIA, W. Beijing Rd, Shanghai, China
| | - Tengbin Xiong
- 0000 0004 1798 0615grid.459847.3Department of Psychiatry, Peking University Sixth Hospital, N. Huayuan Rd, Beijing, China
| | - Xin Yu
- 0000 0004 1798 0615grid.459847.3Department of Psychiatry, Peking University Sixth Hospital, N. Huayuan Rd, Beijing, China
| | - Suodi Zhai
- Department of Pharmacy, Peking University Third Hospital, N. Huayuan Rd, Beijing, China. .,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China.
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Abstract
INTRODUCTION Schizophrenia is a chronic and debilitating mental illness characterised by periods of relapse that require resource intensive management. Quantifying the cost of relapse is central to the evaluation of the cost effectiveness of treating schizophrenia. OBJECTIVES We aimed to undertake a comprehensive search of the available literature on the cost of relapse. METHODS We performed a search on multiple databases (MEDLINE, Embase, PsycINFO and Health Management Information Consortium) for any study reporting a cost of relapse or data from which such a cost could be calculated. Costs are reported in 2015 international dollars. RESULTS We found 16 studies reporting costs associated with relapse over a defined period of time and identified a cost associated with hospitalisation for relapse in 43 studies. Eight clinical decision analyses also provided cost estimates. Studies from the US report excess costs of relapse of $6033-$32,753 (2015 Purchasing Power Parity dollars [PPP$]) over periods of 12-15 months. European studies report excess costs of $8665-$18,676 (2015 PPP$) over periods of 6-12 months. Estimates of the cost of hospitalisation for relapse are more diverse, and associated with marked differences in typical length of stay across jurisdictions. CONCLUSIONS Wide ranges in the estimated cost of relapse may reflect differences in sample section and relapse definition as well as practice styles and differences in resource costs. Selection of the most appropriate cost estimate should be guided by the definition of relapse and the analysis setting.
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Affiliation(s)
- Mark Pennington
- King's Health Economics, PO24 David Goldberg Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Paul McCrone
- King's Health Economics, PO24 David Goldberg Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
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Chen S, Wu Q, Qi C, Deng H, Wang X, He H, Long J, Xiong Y, Liu T. Mental health literacy about schizophrenia and depression: a survey among Chinese caregivers of patients with mental disorder. BMC Psychiatry 2017; 17:89. [PMID: 28274209 PMCID: PMC5343538 DOI: 10.1186/s12888-017-1245-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 02/24/2017] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To investigate the knowledge of schizophrenia and depression among caregivers of patients with mental disorder in China. METHOD A convenience sample of 402 caregivers at the Department of Psychiatry of a general hospital in China was investigated (response rate 95.7%), using vignettes based investigation methodology. RESULTS The number of caregivers using the term "depression" to describe the depression vignette was 43.6%, which was significantly higher than the number of caregivers using the term "schizophrenia" to describe the schizophrenia one (28.5%). A high percentage of caregivers believed that "psychiatrist", "psychologist" and "close family members" would be helpful, and the top three most helpful interventions were "becoming more physically active", "getting out and learning more" and "receiving psychotherapy". The number of caregivers endorsed "antipsychotics" and "antidepressants" as helpful for the schizophrenia and the depression vignettes were 82.0 and 80.7%, respectively. Regarding the causes of mental illness, items related to psychosocial factors, including "daily problems" and "work or financial problems", and "weakness of character" were highly rated, with half considered genetic or chemical imbalance causes. CONCLUSION Caregivers expressed a high knowledge about treatments and interventions of mental disorders. But there are still some areas, particularly regarding the recognition and causes of mental disorders, that are in need of improvement. This is particularly the case for schizophrenia.
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Affiliation(s)
- Shubao Chen
- Mental Health Institute of the Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Changsha, Hunan 410011 China
| | - Qiuxia Wu
- Mental Health Institute of the Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Changsha, Hunan 410011 China
| | - Chang Qi
- Mental Health Institute of the Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Changsha, Hunan 410011 China
| | - Huiqiong Deng
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical School at Houston, Houston, USA
| | - Xuyi Wang
- Mental Health Institute of the Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Changsha, Hunan 410011 China
| | - Haoyu He
- Mental Health Institute of the Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Changsha, Hunan 410011 China
| | - Jiang Long
- Mental Health Institute of the Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Changsha, Hunan 410011 China
| | - Yifan Xiong
- Mental Health Institute of the Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Changsha, Hunan 410011 China
| | - Tieqiao Liu
- Mental Health Institute of the Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Changsha, Hunan 410011 China
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