Cost schizophrenia

The validity of pharmacoeconomic data is invariably diminished by two important factors a failure to account for all direct and indirect cost outcomes, and the difficulty of assigning costs to human experiences. In schizophrenia, validity is further reduced by the near-impossibility of conducting trials over several years, or even decades, so as to approach the reality of what is usually a lifelong illness. Given these observations, it would be imprudent to act on the minutiae of data generated in even the best-conducted trials, but it may well be appropriate to draw broad conclusions. 

Albright PS, Livingstone S, Keegan DL (1996). Reduction of healthcare resource utilisation and costs following the use of risperidone for patients with schizophrenia previously treated with standard antipsychotic therapy a retrospective analysis using the Saskatchewan Health Linkable Databases. Clin Drug Invest 11,289-99. 

Almond S, O Donnell O (2000). Cost analysis of the treatment of schizophrenia in the UK a comparison of olanzapine and haloperidol. Pharmacoeconomics 17, 383—9. 

Byrom WD, Garratt CJ, Kilpatrick AT (1998b). Influence of antipsychotic profile on cost of treatment of schizophrenia a decision analysis approach. Inti J Psychiatry Clin Prac. 

Davies LM, Drummond MF (1993). Assessment of costs and benefits of drug therapy for treatment-resistant schizophrenia in the United Kingdom. Br JPsychiatry 162, 38-42. 

Edgell ET, Hamilton SH, Revicki DA, et al (1998). Costs of olanzapine treatment compared with haloperidol for schizophrenia results from a randomized clinical trial. Poster presented at the 21st CINP Congress, Glasgow, July 1998. 

Ginsberg G, Shani S, Lev B (1998). Cost-benefit analysis of risperidone and clozapine in the treatment of schizophrenia in Israel. Pharmacoeconomics 13,231—41. 

Jonsson D, WSlinder J (1995). Cost-effectiveness of clozapine treatment in therapy-refractory schizophrenia. Aaa Psychiatr Scand l 199-201. 

Palmer CS, Revicld DA, Genduso LA, et al (1998). A cost-effectiveness clinical decision analysis model for schizophrenia. Am J Managed Care 4, 345-55. 

Further detailed analyses of the ECA data have been extrapolated to USA national costs (Rice and Miller, 1998). It was calculated that the economic costs of mental disorders in 1990 in the USA totalled US 147.8 billion. Anxiety disorders were the most cosdy, amounting to 46.6 billion, just under a third of the total. Direct costs spent on mental health care totalled 67 billion, of which anxiety disorders accounted for only 11 billion (16.5%). Drug costs were 2191 million, of which anxiety disorders accounted for 1167 million—over half Morbidity costs—the value of goods and services not produced because of mental disorders — amounted to 63.1 billion, with anxiety disorders accounting for 34.2 billion, 54.2% of the total. This reflects the high prevalence of anxiety disorders in the community and the high associated rate of lost productivity. In contrast, patients with affective disorders appeared better able to function (Rice and Miller, 1995). In summary, anxiety disorders are common, disruptive and costly to society drug treatment is a substantial element of treatment costs (11%) compared with, say, schizophrenia (2.2%). 

The anxiety disorders are common and surprisingly disabling conditions. Studies on the health economics of generalized anxiety disorder, panic disorder, social anxiety disorders and obsessive compulsive disorder document the cost to the individual and to society. Attention has focused on the major psychiatric disorders such as depression, schizophrenia and the dementias. Studies suggest that many anxiety disorders are of early onset and too often chronic they are quite common and impose a heavy burden on society. More studies will be needed to discern the fine grain in the survey material and to identify more precisely the location and type of societal costs. These factors will vary from country to country, from district to district, between men and women and between various age groups. 

The advent of novel atypical antipsychotic drugs has sharpened the debate in the UK about the cost burden of schizophrenia to the National Health Service (NHS) and the relative cost-effectiveness of these drugs. Schizophrenia has a prevalence of about 0.5% and a lifetime risk of 1%. Because the disease affects adolescents and has a lifetime course associated with a high degree of hospital and social... 

Although atypical antipsychotic agents may cost several times as much as traditional antipsychotics, drug costs in schizophrenia account for only 1-4% of the total treatment cost (Knapp, 1997). The argument then is that a small increase in drug costs— say to 10% of total cost—may result in disproportionate savings in the highly expensive direct hospital costs, if clinical trial... 

The high costs of schizophrenia have led ro great economic interest in treatments both old and new. The biggest barrier to the prescribing of new dmgs is probably concerns about safety and compliance, but cost is also a major factor (Kerwin, 1996). However,... 

The evidence base for clinical decisions based on cost-effectiveness for the affective disorders is less clear than for schizophrenia. In bipolar disorder the primary effectiveness of the mainstay treatments, lithium and anticonvulsant pharmacotherapy, is undergoing considerable revision (Bowden et al, 2000). Until this is clarified, cost-effectiveness studies are probably premature. Nevertheless the cost burden in bipolar disorder is qualitatively similar to that in schizophrenia, with in-patient costs being the primary burden and associated social costs in treated patients. The drug costs are even less than those for schizophrenia. In Chapter 5 John Cookson suggests there is little economic evidence to drive prescribing decisions. The in-patient burden does not seem to have altered with the introduction of lithium. The only drug-related study (Keck et al, 1996) showed an obvious difference in treatment costs only when lithium was compared with sodium valproate. Since these are both cheap drugs this is unlikely to influence clinical decisions. The main question is what impact... 

Davies LM, Drummond MF (1994). Economics and schizophrenia. The real cost. Br J Psychiatry 165 (suppl. 25), 18-21. 

Figure 12.1 Cost of atypical antipsychotic drugs (clozapine and risperidone) in each country/territory for patients with schizophrenia...

Knapp M (1997). Costs of schizophrenia. British Journal of Psychiatry, 171, 509-518. 

Schizophrenia is a severe, chronic disabling mental disorder. Schizophrenia affects approximately 1% of the population worldwide. Symptomatic onset occurs in late adolescence and early adulthood in males and somewhat later in females, who tend to be somewhat less severely affected. It is estimated to be the seventh most costly medical illness to society in terms of cost of care and loss of productivity, because less than 30% of affected individuals... 

Schizophrenia is a chronic and debilitating mental disorder. It is common, disabhng, strikes early, and usually lasts a lifetime. The costs in human suffering are enormous as are the economic costs. We have a collection of drugs that help the schizophrenia patient, none of which is truly satisfactory in relieving symptoms and aU of which have potentially serious adverse effects. We need to do better. 

Jones PB, Barnes TE, Davies L, Duim G, Lloyd H, Hayhurst KP, Murray RM, Markwick A, Lewis SW. Cost utility of the latest antipsychotic drugs in schizophrenia smdy (CUTLASS 1). Arch Gen Psychiatry 2006 63 1079-87. 

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