[show abstract][hide abstract] ABSTRACT: Schizophrenia is among the most burdensome and costly illnesses worldwide. To estimate the cost of schizophrenia in France, a longitudinal study was carried out between 1998 and 2002. The main objective of this study was to describe and update the cost of schizophrenia in a longitudinal, representative sample of French patients. The second objective was to identify cost drivers in the treatment of schizophrenia.
Based on a cohort of 288 French schizophrenic patients during 2 years of prospective follow-up, this study collected clinical, patient reported outcomes, quality of life, functioning, patient management, care giver involvement and resource utilisation data every 6 months. For each service, information was collected on the type of service, the frequency of attendance and type of intervention provided to the patient. Unit costs were based on available French databases. Mean service use and costs over the five time points were estimated using between-effects regression models.
In the total sample of 288 patients aged 18-64 years, the mean total cost (€ 3 534) was mainly accounted for by the cost of inpatient treatment (€ 1 390) and day care (€ 1 331). The estimate of the annual cost for direct medical health care for all French schizophrenic patients was € 1 581 million, including € 621 million for inpatient treatment and € 595 million for day care (77%). The costs for medication accounted for 16.1% of total annual costs. The remaining costs (6.9%) included visits to psychiatrists, general practitioners, other physicians and psychologists. The direct resource allocation showed inpatient treatment as the main direct cost. Unemployment was identified as a major indirect cost of schizophrenia treatment. Positive and depressive schizophrenia symptoms at baseline and relapse occurrence during the follow-up period were associated with a higher cost of treatment. Health satisfaction or negative symptoms of schizophrenia at baseline were associated with lower costs.
Several cost drivers were identified. Based on the results obtained in France, we suggest further analysis of mechanisms that influence the service-specific costs for schizophrenia in other areas of the world.
BMC Health Services Research 08/2012; 12:269. · 1.77 Impact Factor
[show abstract][hide abstract] ABSTRACT: Atypical antipsychotics have similar clinical efficacy in the treatment of schizophrenia; variability in their tolerability represents the discerning factor in treatment choices. Sertindole has a relatively good tolerability profile that favours long-term patient adherence and, therefore, is associated with lower rates of relapse and rehospitalization.
A model was developed to compare the cost-effectiveness of a 5-year treatment strategy starting with sertindole versus olanzapine, risperidone, aripiprazole or the typical antipsychotic agent, haloperidol.
The model was based on published trials and local clinical practice, and considered costs from the perspective of the Swedish National Health Insurance Board.
All atypical agents were clinically superior and more cost-effective than haloperidol with a cost per quality-adjusted life year gained of approximately 490,000 Swedish kroner. Sertindole was associated with the lowest direct and indirect medical costs, driven by its tolerability profile.
Sertindole represents a useful alternative to the current treatment options available in Sweden. Clinical implications: The relatively good tolerability profile of sertindole translates into lower costs of schizophrenia management, primarily driven by substantially lower direct and indirect costs. Sertindole appears to be a clinically and cost-effective alternative in the management of patients with schizophrenia in Sweden.
Nordic journal of psychiatry 07/2011; 65(6):403-13. · 0.99 Impact Factor
[show abstract][hide abstract] ABSTRACT: Use of the atypical antipsychotic sertindole was suspended for four years due to safety concerns. During the suspension, the regulatory authorities required further studies, including this one, to be conducted. The purpose of this study was to determine if a subset of patients with psychotic illness exists which particularly benefits from sertindole treatment after failure of other antipsychotic drugs, including atypical antipsychotics.
This was a retrospective single-arm observational crossover study of 344 patients, who served as their own controls. Patients mainly from the Sertindole Safety Study who had shown good response to sertindole, and who had followed up to four alternating six month periods of treatment with sertindole and other antipsychotics, were included. (In Period 1 patients took non-sertindole treatment, in Period 2, sertindole was taken, in Period 3, patients reverted to non-sertindole treatment, and in Period 4, sertindole was taken again.) Patient records for each period of treatment were assessed for objective data: number and duration of hospitalizations due to worsening of psychotic symptoms; the amount of self-harming behaviour; indicators of social status. Retrospective evaluation of changes in clinical symptoms from the patients' records was also conducted. Dates and reasons for stopping and/or switching medication were also recorded.
There was improvement in all objective measured parameters during the periods of sertindole treatment. In particular, the average number of hospitalizations per year due to worsening of psychotic symptoms was reduced in the following way in the group studied over four treatment periods: Period 1 (non-sertindole treatment) 3.4; Period 2 (sertindole treatment) 1.0; Period 3 (non-sertindole treatment) 2.0; Period 4 (sertindole treatment) 1.8. The duration of hospitalizations also decreased significantly during the periods of sertindole treatment. Results showed that patients improved in objective social parameters when switched to sertindole treatment; assessment of the patients' affective lives showed a significant increase in the number of patients having a stable relationship during sertindole treatment; and assessment of the number of patients employed showed an increase after the first and second switch to sertindole treatment (from Period 1 to Period 2 and from Period 3 to Period 4, respectively). Adverse events and lack of efficacy were the main reasons for switching to sertindole.
A group of patients benefited from sertindole after other antipsychotic treatments, including that with atypical antipsychotics, had failed. Further studies are needed to investigate if there is a specific patient profile that corresponds to these responders.
[show abstract][hide abstract] ABSTRACT: After sertindole's suspension, health authorities established a specific named-patient use (NPU) programme in order to supply sertindole to patients who did not respond to or did not tolerate alternative treatments. This programme provided the possibility of prospectively following an exhaustive cohort of patients treated with sertindole after its suspension. A survey was performed to assess sertindole's modalities of prescription, assess and document any serious adverse events (SAEs), and assess the mortality rate within the NPU cohort.
The study comprised a survey of sertindole-treated patients in eleven European countries. All patients treated with sertindole within the NPU programme were eligible for the study.
1,432 patients were included in the study. The reason for sertindole prescription was lack of efficacy (approximately 50%) or adverse events (approximately 20%) of other antipsychotic treatments. The mean sertindole dose was 13.4 mg daily. Lack of efficacy and adverse events were reported as reasons for sertindole discontinuation.A total of 97 SAEs were recorded, including ten fatal outcomes, which occurred during the study period or within thirty days after sertindole discontinuation. The all-cause mortality rate was 0.51 per 100 Person-Years of Exposure (95% Poisson confidence interval: 0.23-0.97). QTc prolongation was reported in 15 patients (1.05% of total patients), being a rate of 0.85 per 100 Person-Years of Exposure [95% CI: 0.48-1.41].
Although prescribing and supplying sertindole were subject to administrative constraints, a significant number of patients were treated with sertindole, thus supporting the need for sertindole in specific cases.
[show abstract][hide abstract] ABSTRACT: Little is known about international variations in employment rates among people with schizophrenia or about the factors associated with employment in this disorder.
To describe employment patterns and the variables associated with working in an international sample of people with schizophrenia.
An analysis was made of baseline data from the European Schizophrenia Cohort study, a 2-year investigation of people with schizophrenia in contact with secondary services and living in France, Germany and the UK (n=1208).
Participants were working in all sections of the job market. People who had a degree, were living with their families or had experienced only a single episode of illness were more likely to be working. A continuous illness course, more severe non-psychotic symptoms and drug misuse reduced the odds of employment. There were large variations between centres in employment rates, which were highest in the three German study sites. These differences persisted after adjustment for individual characteristics.
Local social contexts may be as important as individual or illness-related factors in explaining employment status.
The British Journal of Psychiatry 08/2007; 191:30-7. · 6.61 Impact Factor
[show abstract][hide abstract] ABSTRACT: Pharmacoeconomic evaluations are important elements in the decision making process, and decision tree analyses are statistical models that analyse both clinical and economic consequences of medical actions. Using one theoretic model, key confounding variables were identified that constituted a standardised framework for economic evaluation of schizophrenia management. The extent to which they were included in several previously published schizophrenia models was appraised. Five different models were developed, and a systematic review of schizophrenia modelling studies was conducted. Results indicate that atypical antipsychotics may be more or less cost-effective depending upon whether key confounding variables were taken into account, but vigilance is warranted when assessing data because serious discrepancies can occur between different methods of analysis. A need for standardised schizophrenia pharmacoeconomic models exists. Additionally, social rehabilitation should be considered because this may also influence outcomes. Standardising modelling techniques will facilitate adherence to guidelines issued by decision makers.
The European Journal of Health Economics 04/2006; 7(1):19-29. · 1.50 Impact Factor
[show abstract][hide abstract] ABSTRACT: BACKGROUND Zuclopenthixol acetate is a rapid-acting injectable neuroleptic drug with duration of action that allows for administration once every to 2-3 days. METHODS We used an open randomised multicentre controlled clinical trial of 88 inpatients with an acute psychosis of schizophrenia that also evaluated the resource consumption. The objective of this pharmacoeconomic evaluation was to compare cost-effectiveness of zuclopenthixol and haloperidol over a 3-month period. RESULTS Formal caregiver (nurse) time spent on injections and average hospital stay were considerably shorter in the zuclopenthixol group than for haloperidol and resulted in cost savings. A 44% reduction in minutes spent administering care was observed and the actual length of hospital stays was reduced by 5 days. An evaluation of the cost of the two treatment strategies was made. The average cost of treatment was 157 for zuclopenthixol and 86 for haloperidol. This disparity is, however, reduced when considering the difference in the average length of stay, and the significant reduction in treatment time. CONCLUSIONS The cost of the injectable neuroleptic represents a small fraction of the cost of care for acutely psychotic patients. Zuclopenthixol strategy appears to be the most cost-effective alternative.
International Journal of Psychiatry in Clinical Practice 08/2003; 7(3):177-185. · 0.45 Impact Factor
[show abstract][hide abstract] ABSTRACT: To examine the associations of job acquisition and loss in a representative, prospective community sample of people with schizophrenia living in the UK, France and Germany.
A representative sample of twelve hundred and eight people with schizophrenia were recruited from selected secondary mental health services in the U.K, France and Germany and followed up for 2 years. Information on demographic details, psychotic symptoms and work status was collected.
The odds of getting jobs were increased by being resident in Marseille, Leipzig, Hemer and Heilbronn and by a higher regional general population employment rate. The odds were reduced by living in Lyon, a later illness onset, a longer length of illness, a continuous illness course and more severe negative psychotic symptoms. Previous vocational training reduced the odds of losing employment, whilst living in Lyon or Leipzig, harmful use of alcohol and more positive psychotic symptoms at baseline all increased the odds.
In addition to illness related factors, area of residence and local labour market conditions appear to be important in explaining employment status change in people with schizophrenia.
Epidemiologia e psichiatria sociale 18(4):344-51. · 3.16 Impact Factor