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Identifying patient-relevant endpoints among individuals with schizophrenia: An application of patient-centered health technology assessment

  • Elizabeth T. Kinter (a1), Annette Schmeding (a2), Ina Rudolph (a2), Susan dosReis (a1) and John F. P. Bridges (a3)...

Objectives: Schizophrenia imposes a great burden on society, and while evaluation should play an important role in informing society's efforts to alleviate these burdens, it is unclear what “endpoints” should be chosen as the objective of such analyses. The objectives of the study were to elicit endpoints directly from patients with schizophrenia, to ascertain whether patients are sufficiently cognoscente to express what endpoints are and are not important to them and to rank the relevant endpoints.

Methods: We applied principles of patient-centered health technology assessment to identify and value endpoints from the patient's perspective. Focus groups were conducted to elicit endpoints, using interpretive phenomalogical analysis (IPA) to guide the collection, analysis and interpretation of data. Patient interviews were subsequently used to elicit patient preference over endpoints. Respondents were presented with cards outlining the endpoints and asked to remove irrelevant cards. They where then asked to identify and rank their five most relevant endpoints in order of importance. Interviews were recorded for the purposed of triangulation, and data was analyzed using descriptive statistics. Patients were recruited from five geographically diverse cities in Germany. Eligibility required a diagnosis of schizophrenia by a physician and treatment with an antipsychotic medication for at least one year. Respondents were excluded if they were experiencing an acute episode.

Results: Thirteen endpoints emerged as important from the focus groups spanning side-effects, functional status, processes of care and clinical outcomes. Respondents could clearly identify relevant and irrelevant endpoints, and rank which factors were important to them. Triangulation between field notes of the ranking exercise and recordings confirmed that rankings were not arbitrary, but justified from the respondents' point of view.

Conclusions: Patients with schizophrenia can express preferences over endpoints. Our results show that qualitative methods such as IPA can be used to identify factors, but ranking exercises provide a more robust method for ranking the importance of endpoints. Future research involving patients with schizophrenia ranking outcomes is needed to identify variations across patients and methods such as conjoint analysis could prove beneficial in identifying acceptable tradeoffs across endpoints.

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2. R Baker , C Thompson , R Mannion . Q methodology in health economics. J Health Serv Res Policy. 2006;11:3845.

3. B Bandelow , P Muller , W Gaebel , Depressive syndromes in schizophrenic patients after discharge from hospital. ANI Study Group Berlin, Dusseldorf, Gottingen, Munich. Eur Arch Psychiatry Clin Neurosci. 1990;240:113120.

6. SA Bull , XH Hu , EM Hunkeler , Discontinuation of use and switching of antidepressants: Influence of patient-physician communication. JAMA. 2002;288:14031409.

7. E Chapman , R Smith . Interpretative phenomenological analysis and the new genetics. J Health Psychol. 2002;7: 125130.

11. TE Goldberg . Some fairly obvious distinctions between schizophrenia and bipolar disorder. Schizophr Res. 1999;39:127132.

13. A Haycox . Pharmacoeconomics of long-acting risperidone: Results and validity of cost-effectiveness models. Pharmacoeconomics. 2005;23 (Suppl):316.

17. M Knapp , D Chisholm , M Leese , Comparing patterns and costs of schizophrenia care in five European countries: The EPSILON study. European psychiatric services: Inputs linked to outcome domains and needs. Acta Psychiatr Scand. 2002;105:4254.

18. Y Lecrubier , R Perry , G Milligan , Physician observations and perceptions of positive and negative symptoms of schizophrenia: A multinational, cross-sectional survey. Eur Psychiatry. 2007;22:371379.

19. JA Lieberman , TS Stroup , JP McEvoy , Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med. 2005;353:12091223.

21. Y Maurer , A. Dittrich [Comparison of psychiatrist's rating and self rating of schizophrenic patients (author's transl)]. Pharmakopsychiatr Neuropsychopharmakol. 1979;12:375382.

22. JP McEvoy , JA Lieberman , TS Stroup , Effectiveness of clozapine versus olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia who did not respond to prior atypical antipsychotic treatment. Am J Psychiatry. 2006;163:600610.

23. G Mooney . What else do we want from our health services? Soc Sci Med. 1994;39:151154.

24. D Naber , A Karow . Good tolerability equals good results: The patient's perspective. Eur Neuropsychopharmacol. 2001;11 (Suppl 4):S391S396.

26. JM Pyne , C Labbate . Ranking of outcome domains for use in real-time outcomes feedback laboratory by patients with schizophrenia. J Nerv Ment Dis. 2008. 196:336339.

27. R Rosenheck , S Stroup , R Keefe , Measuring outcome priorities and preferences in people with schizophrenia. Br J Psychiatry. 2005;187:529536.

28. M Ryan . Using conjoint analysis to take account of patient preferences and go beyond health outcomes: An application to in vitro fertilization. Soc Sci Med. 1999;48:535546.

29. P Thomas . The stable patient with schizophrenia–from antipsychotic effectiveness to adherence. Eur Neuropsychopharmacol. 2007;17 (Suppl 2):S115-S122.

30. F Vogt , DL Schwappach , JF Bridges . Accounting for tastes: A German perspective on the inclusion of patient preferences in healthcare. Pharmacoeconomics. 2006;24:419423.

31. EQ Wu , HG Birnbaum , L Shi , The economic burden of schizophrenia in the United States in 2002. J Clin Psychiatry. 2005;66:11221129.

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International Journal of Technology Assessment in Health Care
  • ISSN: 0266-4623
  • EISSN: 1471-6348
  • URL: /core/journals/international-journal-of-technology-assessment-in-health-care
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