[The cost of schizophrenia in Germany: a systematic review of the literature].
Klinik und Poliklinik für Psychiatrie, Universität Leipzig, Leipzig. Psychiatrische Praxis
(Impact Factor: 1.64).
The aim of this study was a systematic literature review of cost-of-illness studies for schizophrenia in Germany.
We conducted a database search in Pubmed and PsychINFO. Cost data were inflated to the year 2007.
We finally included 11 studies in our review which show that schizophrenia causes societal cost of several billion Euros per year. After adjustment for inflation, costs per patient and year estimated between 1980 and 2002 tended to be relatively stable at around 14,000 to 18,000 Euro. Additionally, relatives are confronted with spending of 950 to 1,700 Euro due to the patients' disorder. Indirect costs are mainly due to early retirement or unemployment and amount to 25,000 to 30,000 Euro per patient when using the human capital approach. We found that changes in treatment settings and increasing costs of drug treatment seem to be reflected in published cost-of-illness studies.
When corrected for inflation, treatment cost per patient for schizophrenia show changes in their distribution over different cost sectors in the health care system but no substantial increases between 1980 and 2002.
Available from: Nikolaos Koutsouleris
- "Patients with schizophrenia are at significantly increased risk of suicide and frequently suffer socio-economic disadvantages. The costs to society include direct costs, such as treatment, as well as indirect costs, such as loss of manpower at work due to the illness or due to caring by relatives (2, 3). Current pharmacological treatments of schizophrenia are successful at reducing psychotic symptoms but do not provide a cure (4), especially given that neurocognitive deficits and negative symptoms appear less amenable to treatment than psychotic phases of the disorder. "
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ABSTRACT: Schizotypy refers to a set of temporally stable traits that are observed in the general population and that resemble the signs and symptoms of schizophrenia. Here, we review evidence from studies on genetics, cognition, perception, motor and oculomotor control, brain structure, brain function, and psychopharmacology in schizotypy. We specifically focused on identifying areas of overlap between schizotypy and schizophrenia. Evidence was corroborated that significant overlap exists between the two, covering the behavioral brain structural and functional as well molecular levels. In particular, several studies showed that individuals with high levels of schizotypal traits exhibit alterations in neurocognitive task performance and underlying brain function similar to the deficits seen in patients with schizophrenia. Studies of brain structure have shown both volume reductions and increase in schizotypy, pointing to schizophrenia-like deficits as well as possible protective or compensatory mechanisms. Experimental pharmacological studies have shown that high levels of schizotypy are associated with (i) enhanced dopaminergic response in striatum following administration of amphetamine and (ii) improvement of cognitive performance following administration of antipsychotic compounds. Together, this body of work suggests that schizotypy shows overlap with schizophrenia across multiple behavioral and neurobiological domains, suggesting that the study of schizotypal traits may be useful in improving our understanding of the etiology of schizophrenia.
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ABSTRACT: The purpose of this study is to analyse the effectiveness of flupentixol compared to other first- and second-generation antipsychotics for the treatment of schizophrenia in routine care.
A retrospective cohort study was conducted using administrative data from four sickness funds covering 12.6 million insured. Patients discharged from hospital in 2003 with an ICD-10 diagnosis of schizophrenia were followed for 12 months. Rehospitalisation during follow-up was analysed using a hurdle regression model. Treatment costs were defined as cost of pharmaceutical and cost of inpatient care. Two thousand eight hundred ninety insured were included, of which 177 were treated with flupentixol during follow-up, while 429 and 2,284 were treated with other first-and second-generation antipsychotics, respectively.
Compared to patients treated with flupentixol (21.0 days), predicted hospitalisation did not differ significantly for patients treated with other first- (21.3 days, p = 0.8313) or second-generation antipsychotics (25.6 days, p = 0.4035). Predicted treatment costs for the average patient were 4,193 Euro if treated with flupentixol, 4,846 Euro if treated with other first-generation antipsychotic, and 6,523 Euro if treated with a second-generation antipsychotic. Second-generation antipsychotics showed a clear advantage over flupentixol concerning extrapyramidal symptoms co-medication.
The effectiveness of flupentixol preventing relapse in patients with schizophrenia appears to be similar to that of other first- and second-generation antipsychotics. However, the low treatment costs for patients treated with flupentixol could be explained by the small number of patients with readmissions (70 insured) and the larger share of patients treated with its depot formulation.
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ABSTRACT: OBJECTIVE: Interest in cardiovascular diseases (CVD) in schizophrenia has grown recently due to documented incremental mortality. C-reactive protein (CRP) has been assessed as a marker in individuals with CVD and/or at high risk of developing it. However, its role in schizophrenia patients is unknown. The goal of this research was thus to explore the use of CRP as a marker of CVD risk in patients with schizophrenia. METHODS: A cross-sectional analysis of the Badalona Serveis Assistencials (BSA) administrative claims database was conducted including all subjects aged>18 years with a diagnosis of schizophrenia spectrum disorder. CRP measurement, sociodemographics, medical history, 10-year CVD risk (Framingham function) and clinical chemistry data were extracted for analysis. RESULTS: Seven hundred and five patients (53.0% men, 48.2 [15.8] years, 78.7% on atypicals) met criteria for analysis. Mean 10-year CVD risk was high; 11.9±5.7% and mean CRP levels were 2.6±2.5mg/L with 30.4% showing above-normative levels (>3mg/L). After adjusting for age, gender, smoking and presence of neoplasm or inflammatory diseases, CRP was linearly associated with 10-year CVD risk stratified by risk (low, moderate, high/very high): respectively, 2.3 (95% CI: 2.1-2.5), 3.1 (2.6-3.5) and 3.7 (3.2-4.1) mg/L; F=13.5, P<0.001. Patients with known CVD also showed higher CRP levels: 3.7 (2.9-4.5) vs. 2.5 (2.4-2.7) mg/L, P=0.008; and higher probability of above-normal values; odds ratio=4.71 (2.01-11.04), P<0.001. CONCLUSIONS: High CRP levels above normative were associated with both known CVD and high/very high 10-year risk of a CVD event in patients with schizophrenia, suggesting CRP could be a marker of CVD in this psychiatric disorder.
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