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How much of the burden of schizophrenia is alleviated by treatment?

  • Richard Warner (a1)
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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How much of the burden of schizophrenia is alleviated by treatment?

  • Richard Warner (a1)
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eLetters

Methodological pitfalls of economic evaluations of schizophrenia treatment burden!

Dr.Naseem A. Qureshi
26 November 2003

The study by Andrews and colleagues [Andrews et al, 2003] is mind-boggling because most of us have no basic knowledge of the standard principles underlying the cost-effective evaluations of schizophrenia treatment. Indeed, schizophrenia is a costly and complicated disorder to treat. This Australian study invited additional views of eminent experts [Goldberg, 2003;Warner, 2003] who revealed its many pitfalls and eventually expanded the scope of further exploring the multi-billion dollar question, " How much of the burden of schizophrenia is alleviated by treatment?" However, according to their invaluable remarks, this question is unanswerable. This may be true because in the first place mental health economic experts have not answered the basic question, which is “how much economic burden does untreated schizophrenia cause worldwide?” In real world situations, the former question can not be answered precisely if the latter question is not explored and answered first. Most importantly,a study like the one under discussion can not include all the variables highlighted by Warner (2003) and Goldberg (2003), which certainly have an impact on the economicanalysis of schizophrenia treatment burden. Furthermore, a brief review ofrelevant literature reveals that almost all studies on pharmacoeconomic evaluations of severe mental disorders fail to meet qualitative standards and hence tend to have some methodological limitations. So, the two critics’ comments are not exceptions to Andrews team’s research.

Notably, there are other important factors that also have an impact on the pharmacoeconomic evaluations of schizophrenia. These are adverse effects of antipsychotic therapy [Nasrallah 2003], individual patient characteristics such as severely impaired sustained attention [Ko et al 2003] and persistent auditory hallucinations [Stant et al 2003], patients’ social characteristics in particular role-functioning capacities [Kilian et al 2003], ill-defined and inaccurate measures of non-compliance with antipsychotic medications [Thieda et al, 2003], antipsychotic monotherapy versus polytherapy and switch and augmentation strategies, longer-term clinical outcomes, underuse of recommended treatment guidelines and medication treatment algorithms [Loosbrock & Zhao, 2003; Rush et al 2003], regional variations, drug choice, comorbid physical diseases, such as HIV and diabetes mellitus [Rascati et al 2003], and others including relative lackof good economic evaluations [Cleemput et al 2002].

Furthermore, pharmacoeconomic studies should also take into account not only modern medications but also psychosociocultural interventions for the enhancement of general functioning of patients with schizophrenia or other severe psychotic disorders. Economic evaluations of schizophrenia treatment burden must also include traditional treatments/complementary alternative medicines often used by patients with chronic severe mental disorders.

Declaration of interest: none

References

Andrews G, Sanderson K, Corry J, Issakidis C, Lapsley H. Cost-effectiveness of current and optimal treatment for schizophrenia Br J Psychiatry 2003;183:427-435

Cleemput I, Kesteloot K, DeGeest S. A review of the literature on theeconomics of noncompliance. Room for methodological improvement.Health Policy 2002;59:65-94

Goldberg D. Invited commentary on: Cost-effectiveness of current and optimal treatment for schizophrenia B J Psychiatry 2003 183:436

Kilian R, Matschinger H, Becker T et al.A longitudinal analysis of the impact of social and clinical characteristics on the cost of schizophrenia. Acta Psychiatr Scand 2003;107:351-360

Ko SY, Chen PS, Yang YK et al.Correlation between performance on theContinuous Performance Test and economic costs in patients with schizophrenia. Psychiatr Clin Neurosci 2003;57:373-377

Loosbrock DL, Zhao Z. Antipsychotic medication use patterns and associated costs of care for individuals with schizophrenia. J Ment HealthPolicy Econ 2003;6:67-75

Nasrallah HA.Pharmacoeconomic implications of adverse effects during antipsychotic drug therapy. Am J Health Syst Pharm 2002; 59(22 Suppl 8):S16-21

Rascati KL, Johnsrud MT, Crismon ML et al. Olanzapine versus risperidone in the treatment of schizophrenia:a comparison of costs among Texas Medicaid recipients. Pharmacoeconomics 2003;21:683-697

Rush AJ, Crismon ML, Kashner TM et al.Texas Medication Algorithm Project, phase 3(TMAP-3):rationale and study design.J Clin Psychiatry 2003;64:357-369

Stant AD, TenVergert EM, Groen H et al.Cost-effectiveness of the HIT programme in patients with schizophrenia and persistent auditory hallucinations.Acta Psychiatr Scand 2003;107:361-368

Thieda P, Beard S, Richter A, Kane J. An economic review of compliance with medication therapy in the treatment of schizophrenia. Psychiatr Serv 2003; 54: 508-16

Warner R.How much of the burden of schizophrenia is alleviated by treatment? B J Psychiatry 2003 183: 375-376.

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