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PMH1 |
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MENTAL HEALTH SERVICES AND
DRUG UTILIZATION PATTERNS FOR STUDENTS WITH MENTAL
ILLNESSES IN SCHOOL-BASED HEALTH CENTERS
Guo JJ1, Keller KN2, Jang R1, Cluxton RJ1,
1University of Cincinnati, Cincinnati, OH, USA,
2Health Foundation of Greater Cincinnati,
Cincinnati, OH, USA OBJECTIVE:
Mental health problems among children and
adolescents do not have sufficient attention in
the US. The purpose of this study was to assess
direct health care costs and drug utilization for
students with mental health illnesses in
School-Based Health Centers (SBHC) and comparable
schools. METHODS:
Four SBHC intervention schools
and two comparable non-SBHC schools in Greater
Cincinnati, Ohio were selected for this study. A
total of 1200 students who were enrolled in
Medicaid program and had at least one mental
illness diagnosis and received mental health
medications were identified for this cohort. There
were 850 students in those schools with SBHCs, and
350 students in non- SBHCs. The study period was
from August 1997 to August 2002. Repeated measures
analysis of covariates was conducted to assess the
cost and mental health services before and after
the SBHC program. RESULTS:
The cohort involved
64.8% male, 40.7% African- American, and average
9.8 (SD 2.65) years-old in September 2001. During
the study period, average monthly total costs were
$221 (SD 692) before SBHC and $295 (SD 742) after
SBHC. The most frequently diagnosed mental
illnesses for all students were hyperkinetic
syndrome of childhood, adjustment reaction,
disturbance of emotion/conduct, affective
psychoses, neurotic disorders, and specific delays
in development. Frequently prescribed medications
were antihyperkinesis agents (4.3 Rx per student),
anticonvulsants (2.8 Rx/student), adrenergics/
amphetamine (2.4 Rx/student), antidepressants (2.3
Rx), and antipsychotics (1.9 Rx/student). After
controlling for demographics and Medicaid
enrollment status, ANCOVA indicated a significant
SBHC intervention effect (Time*SBHC) for both
monthly total cost (F=8.82, p=0.003) and monthly
mental health service cost (F=5.06, p=0.025).
CONLUSIONS:
The SBHC program that provides mental
health services for students did not decrease the
total Medicaid costs, instead, might increase the
health quality and health care accessibility for
those students.
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PMH2 |
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COST-EFFECTIVENESS OF
OLANZAPINE VERSUS LITHIUM FOR THE PREVENTION OF
RELAPSE IN BIPOLAR I DISORDER IN AUSTRALIA
Price N1, Davey P1, Mudge M1, Fitzgerald
B2, Rajan N2, Montgomery B2, 1M-TAG Pty Ltd, A
Unit of IMS, Chatswood, NSW, Australia, 2Eli Lilly
Australia Pty Ltd, West Ryde, NSW, Australia
OBJECTIVE:
To assess the cost-effectiveness of
olanzapine compared with lithium in relapse
prevention of bipolar I disorder. METHODS:
Resource use data from a 52-week double-blind
randomised controlled trial of olanzapine versus
lithium (n = 431) were used to determine costs of
both treatments. Resources considered were study
drug, concomitant medication, hospitalisations and
laboratory tests. This trial also reported
relative safety and efficacy. Australian cost data
were applied to the resource utilisation from the
trial to estimate the overall treatment costs
associated with each therapy. Study drug and
concomitant medication prices were sourced from
the Schedule of Pharmaceutical Benefits and
E-MIMS, while national casemix costs were applied
to hospitalisations. Rather than episodic costing,
a mixture of fixed and marginal costs were used.
Laboratory test prices were from the Medicare
Benefits Schedule. RESULTS:
The overall cost of
therapy for olanzapine patients was A$9340
(US$6452), compared with A$9589 (US$6624) for
lithium patients. Although the acquisition cost of
olanzapine is greater than for lithium, the fewer
(82 vs. 88) and shorter hospitalisations (15 vs.
19.7 days) associated with olanzapine relative to
lithium therapy lead to this overall cost saving
of A$249 (US$172). Olanzapine patients do not
require laboratory tests to monitor serum lithium
levels, which also contributes to the cost saving.
In terms of efficacy, 8.8% (p=0.055) fewer
olanzapine patients relapsed compared with lithium
patients. Additionally, 13.7% (p<0.001) fewer
olanzapine patients suffered manic relapse. Time
to relapse analysis confirmed that benefits from
olanzapine are maintained over a longer period
than those of lithium. Hence, the probability of
relapse diverges over time. When costs were varied
in sensitivity analyses, olanzapine continued to
be cost-effective. CONLUSIONS:
Olanzapine
displays greater efficacy and is cost-saving
compared to lithium. Hence, olanzapine represents
a dominant therapeutic option. Sensitivity
analysis indicated that even in extreme
circumstances, olanzapine remains cost-effective.
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PMH4 |
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ECONOMIC BURDEN OF DEPRESSED
PATIENTS IN SHANGHAI
Chen XB1, Ji JL2, Tan-Mulligan A3, Sheng F3,
1Fudan University, Shanghai, China, 2Zhongshan
Hospital, Fudan University, Shanghai, China,
3GlaxoSmithKline Pharmaceuticals China, Shanghai,
China OBJECTIVE:
The aim of
this study was to evaluate the annual economic
burden of the patients suffering from depression
in Shanghai. METHODS:
A bottom-up, prevalencebased
design was used, this study evaluated 652
outpatients with depression in seven hospitals in
Shanghai and all patients were diagnosed by a
senior psychiatrist or psychologist based on
CCMD-3 diagnostic criteria. The data were
collected from treatment records and follow-up
interview of the clients. The annual economic
burden attributed to the major depression was
calculated, including annual direct medical
expenditures, direct non-medical expenditures &
indirect expenditures. The indirect expenditure
was calculated based on human capital approach.
RESULTS:
1) The total annual economic burden of
depressed patients in Shanghai was estimated at
RMB 354 million a year(2003 values), the estimated
average yearly direct medical cost in Shanghai was
around RMB 177 million. 2) The annual economic
burden of pure depressed patients was higher than
that of co-morbidity with anxiety symptoms
patients, RMB 7342 and 6167 respectively, the
average RMB 6809. 3) Pure depressed patients has a
higher indirect expenditures (RMB 2932.61, i.e
39.94% in total annual economic burden) compared
to patients with anxiety co-morbidity (RMB 757.95,
only 12.29%); but these patients have a higher
direct expenditures (RMB 5409.54) compared to pure
depression patients (RMB 4409.50). 4) Drug Cost
for managing depressed patients were relatively
very high, accounting for 86% of the total
healthcare costs in a visit. 5) 49.4% of their per
capita disposable income was spent due to the pure
depression and 41.5%, co-morbidity with anxiety
symptoms. CONLUSIONS:
Both pure depressed &
co-morbidity with anxiety symptoms patients create
a huge burden on the patients, their families, and
the society.
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PMH5 |
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PRICE AND UTILIZATION OF
ANTIDEPRESSANTS IN U.S. MEDICAID PROGRAMS
Guo JJ, Jing Y, Chen Y, Kelton CM, Patel N,
University of Cincinnati, Cincinnati, OH, USA
OBJECTIVE:
Antidepressants are frequently used for
the treatment of depressive and anxiety disorders.
Three major classes of antidepressants are
selective serotonin reuptake inhibitors (SSRIs),
tricyclic antidepressants (TCAs), and other
antidepressants. The objectives of this study are
to describe drug price and utilization trends in
each subcategory of antidepresants. METHODS:
The
First DataBank national drug file was used to
calculate the monthly average wholesale price
(AWP) per daily dose from 1986 to 2002. Using the
Centers for Medicare & Medicaid Services
prescription drug database, we constructed
quarterly per-prescription reimbursement figures
for each drug from 1991 to 2004. Descriptive
interrupted time-series analyses were conducted to
quantify drug utilization and price trends.
RESULTS:
The average AWP per daily dose for all
branded drugs increased over time regardless of
new agent entry or patent expiration. The
reimbursement costs per prescription for Prozac
and Luvox dropped when their generics entered. The
average cost per SSRI prescription increased from
$60 in 1991 to $110 in 2001, then decreased to $90
in 2004 due to generic entry. The proportion of
total expenditure for SSRIs increased from 13% in
1991 to 57% in 2004, while spending on TCAs
decreased from 74% in 1991 to 12% in 2004.
CONLUSIONS:
Large increases in antidepressant
drug expenditures have accompanied increased SSRI
utilization. With growing concerns over high drug
expenditure, we need to explore more the factors
affecting drug-pricing strategy.
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PMH6 |
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DIFFERENCES IN THE COST OF
ANTIDEPRESSANTS ACROSS STATE MEDICAID PROGRAMS
Kelton CM1, Guo JJ1, Rebelein RP2, Ferrand Y1,
1University of Cincinnati, Cincinnati, OH, USA,
2Vassar College, Poughkeepsie, NY, USA
OBJECTIVE:
Depression is the most prevalent major
mental health disorder, affecting between four and
eight percent of the population in the U.S.
Expenditure on antidepressants is very high and
rising rapidly due to both rising utilization and
rising prices. The U.S. Medicaid programs spent in
total over $2.3 billion on antidepressant drugs in
2003. Our objectives are: 1) to describe in detail
state Medicaid spending on antidepressants, and 2)
to determine the magnitude and significance of the
effects of state Medicaid cost-containment drug
policies on reimbursement cost. METHODS:
Pharmacy
data from the Centers for Medicare & Medicaid
Services were used to calculate state expenditures
on antidepressants and number of prescriptions for
antidepressants. Policy variables were taken from
a 2003 Kaiser Commission report, while demographic
data (income per capita, percentage rural,
percentage elderly, and so forth) were taken from
the Census of Population. Regression analysis is
used to explain reimbursement per prescription and
percent of prescriptions filled by generic,
instead of branded, medications. RESULTS:
Total
spending on antidepressants in 2003 ranged from
$2.8 million for Washington, D.C., to $218.1
million for New York state, with approximately
two-thirds of the spending for SSRI
antidepressants. Average reimbursement per
prescription was $62.69, with the minimum in
Michigan ($49.86) and the maximum in California
($78.54). The average portion of generic
prescriptions was 37.6%, with a minimum of 26.0%
in Delaware (implying 74.0% of prescriptions were
for branded pharmaceuticals) and a maximum of
47.3% percent in Wisconsin. Regression results
suggest that more populated states have higher
reimbursements per prescription and lower generic
percentages. CONLUSIONS:
There is considerable
variation across states in reimbursement costs for
antidepressant prescriptions. While states have
adopted a number of different cost-containment
policies, there is no indication that any of the
policies improves the state’s per-prescription
cost position relative to other states.
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PMH7 |
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STATE BASED DIFFERENCES IN
THE USE OF ANTIPSYCHOTIC MEDICATIONS BY HOSPITALS
IN AUSTRALIA – 2004
Montgomery WS1, Kulkarni J2, Bradley MN1,
1Eli Lilly Australia, West Ryde, NSW, Australia,
2Alfred Psychiatry Research Centre, Melbourne,
VIC, Australia
OBJECTIVE:
To analyse by geography, in this case
by state, the usage patterns of the different
antipsychotic medications purchased by public and
private hospitals in Australia. METHODS:
National
hospital sales data for all antipsychotic
medications purchased by 565 hospitals were
obtained from IMS Health Australia for the period
January 2004 to December 2004. This was segregated
into the major states and territories of Australia
(New South Wales, Northern Territory, Queensland,
South Australia, Tasmania, Victoria & Western
Australia). This was then converted into defined
daily doses (DDDs) for each agent. The level of
antipsychotic use in each state was expressed as
the estimated DDDs per 1000 population/day.
RESULTS:
Significant variation by state was seen
in the usage of antipsychotics across Australia.
Nationally the atypical antipsychotics were the
most frequently used class of agents, accounting
for 69% of total use. The use of individual
atypical agents varied significantly across
geographies. Clozapine use varied from a high of
42% in Victoria to 13% in SA and WA. Depot typical
antipsychotics were the most commonly used class
of agents (39%) in NT, whereas they only accounted
for 15% of use in Victorian hospitals. Oral
typical agents were most frequently used in SA
(17%) and least used in WA (6%) and Vic (7%).
CONLUSIONS:
Significant variation in
antipsychotic usage patterns by hospitals is seen
between the different states in Australia.
Community usage patterns, by comparison, show much
less variation. Such information has the potential
to be used as an indicator of quality of care in
mental health services.
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PMH8 |
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PRICE AND UTILIZATION TRENDS
OF ANTIPSYCHOTICS IN U.S. MEDICAID PROGRAMS
Guo JJ1, Kelton CM1, Jing Y1, Chen Y1, Louder A2,
Patel N1, 1University of Cincinnati, Cincinnati,
OH, USA, 2Anthem Health Care, Mason, OH, USA
OBJECTIVE:
Antipsychotics are classified as either
typical or atypical. Despite being expensive,
atypical antipsychotics have increasingly been
used in the past decade due to improved
tolerability, replacing the use of typical
antipsychotics. Our objective is to examine
typical and atypical antipsychotic price and
utilization trends. METHODS:
The First DataBank
national drug file was used to calculate the
monthly average wholesale price (AWP) per daily
dose from 1986 to 2002. Using the Centers for
Medicare & Medicaid Services Medicaid Pharmacy
databases, we constructed quarterly
per-prescription reimbursement figures for each
brand-name and generic drug from 1991 to 2004.
Descriptive interrupted time-series analyses were
conducted to quantify drug utilization and price
trends. RESULTS:
The average AWP shows that
atypical antipsychotics are relatively expensive
compared to typical antipsychotics. Generic
clozapine was introduced at a price 90% of the
branded drug’s price, then dropped gradually over
time. The average AWPs for all branded drugs,
including Hadol, Thorazine, Loxitane, Risperdal,
Zyprexa, and Geodon, increased over time. The
average reimbursement cost per atypical
prescription incrased from $80 in 1991 to $240 in
2004, while the average cost per typical
prescription was relatively stable with the
exceptions of Haldol and Loxitane. The total
Medicaid expenditure on antipsychotics increased
sharply from $135 million per quarter in 1991 to
$1.25 billion per quarter in 2004, due to the
increased use of atypical antipsychotics.
CONLUSIONS:
Dramatic increases in antipsychotic
drug expenditures paralleled increases in the use
of atypical antipsychotics. As additional safety
data for atypical antipsychotics become available,
it will be important to determine whether they
affect drug utilization of specific agents.
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PMH9 |
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ANTIPSYCHOTIC UTILIZATION
TRENDS AMONG TEXAS VETERANS
Yang M, Barner JC, University of Texas at Austin,
Austin, TX, USA\ OBJECTIVE:
To
understand antipsychotic utilization trends and
factors associated with index medication selection
(second generation antipsychotics – SGAs vs. first
generation antipsychotics – FGAs) among Texas
veterans newly initiated on antipsychotics.
METHODS:
Data were extracted from the computerized
patient record system of Veterans Administration
North Texas Health Care System (VANTHCS) and South
Texas Veteran Health Care System (STVHCS).
Prescriptions were available from January 1, 1996
to December 31, 2003. For all of the patients
newly started on antipsychotics, prescriptions
were followed for up to 12 months. Descriptive
analyses were used to examine utilization trends;
logistic regression was used to examine the
factors associated with antipsychotic index
medication selection. RESULTS:
A total of 4,809
patients were included (n=3,079 in VANTHCS;
n=1,730 in STVHCS) with the majority being male
(93.6%), ³55 years old (44.1%) and white (62.6%).
Descriptive analyses revealed that antipsychotic
prescriptions had changed from primarily FGAs
(71.7% in 1997, 25.2% in 1999, and 5.7% in 2002)
to SGAs. Olanzapine (30.7%) and risperidone
(31.0%) were most commonly prescribed and the
preferred SGA was different between VANTHCS –
olanzapine and STVHCS – risperidone. Use of
antipsychotic switching (17.8%) and combination
therapy (6.0%) increased over the last few years,
but monotherapy was still dominant (76.2%). In
addition to schizophrenic patients, antipsychotics
were also commonly prescribed for patients with
other mental illness disorders. Logistic
regression found that when compared to white
patients, Hispanic and black patients were less
likely to start on SGAs. Older patients, with a
hypertension diagnosis, patients in STVHCS were
less likely to start on SGAs. Patients with
dyslipidemia, and patients started treatment in
recent years were more likely to have SGAs as the
index medications. CONLUSIONS:
This study found
that SGAs replaced FGAs as the primary medications
for patients with mental illness disorders. Race,
age, comorbidity and treatment exposure time are
important factors in index medication selection.
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PMH10 |
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TIME TO ALL-CAUSE
DISCONTINUATION OF ATYPICAL VERSUS TYPICAL
ANTIPSYCHOTICS IN THE NATURALISTIC TREATMENT OF
SCHIZOPHRENIA
Zhu B1, Swartz M2, Ascher-Svanum H1, Faries
DE1, Tunis SL1, Swanson J3, Landbloom R1, 1Eli
Lilly and Company, Indianapolis, IN, USA, 2Duke
University Medical Center, Durham, NC, USA, 3Duke
University School of Medicine, Durham, NC, USA
OBJECTIVE:
To prospectively compare atypical and
typical antipsychotics on time to allcause
medication discontinuation, an important
effectiveness measure in the usual care of
patients with schizophrenia. METHODS:
Participants
(N=1704) were initiators on oral atypical or
typical antipsychotics (low, medium, or
high-potency) in a three-year naturalistic study
of schizophrenia. Medication groups were compared
on time to all-cause medication discontinuation
during the one-year following medication
initiation. Statistical analysis used Kaplan-Meier
and Cox proportional hazard models. RESULTS:
Patients treated with atypical antipsychotics had
longer time to medication discontinuation compared
to patients receiving low, medium, or high-potency
typical antipsychotics (odds ratio= 1.4, 1.5, 1.9;
p= 0.044, 0.004, <0.001, respectively). Among
atypical antipsychotics, clozapine and
olanzapine-treated patients had a significantly
longer time to medication discontinuation than
patients receiving low, medium, or high-potency
typical agents. Risperidone and quetiapine-
treated patients had a longer time to medication
discontinuation compared to only high-potency
typicals. Ziprasidone did not significantly differ
from low, medium, or highpotency typical agents.
Further, only clozapine- and olanzapine-treated
patients had a significantly significantly longer
time to medication discontinuation compared to
perphenazine, a mediumpotency typical
antipsychotic. CONLUSIONS:
In usual care of
schizophrenia patients, atypical antipsychotics
appear to be superior to typical antipsychotics
(regardless of potency level), and to
significantly differ in treatment effectiveness.
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PMH11 |
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EFFECTIVENESS AND
TOLERABILITY COMPARISON OF RISPERIDONE LONG-ACTING
INJECTION AND CONVENTIONAL DEPOT ANTIPSYCHOTICS IN
A LARGE CANADIAN PSYCHIATRIC HOSPITAL
Welch RP, Snaterse MH, Alberta Hospital
Edmonton, Edmonton, AB, Canada
OBJECTIVE:
To evaluate the effectiveness and
tolerability of risperidone long-acting injection
(RLAI) as compared to the usual treatment
alternative of conventional depot antipsychotics.
METHODS:
Patients initiated on RLAI during the
four-month period of March 2004 through June 2004
were compared to patients initiated on a
conventional depot antipsychotic during the same
time period. Patient demographics including age,
gender, diagnosis, number of previous psychiatric
admissions and in-patient program were evaluated.
The effectiveness outcomes of antipsychotic
polypharmacy, discharge and readmission rates were
compared. Neurological tolerability was assessed
as measured by the prescribing of anticholinergic
side-effect medications. RESULTS:
Forty patients
initiated on RLAI were compared to 49 patients
initiated on a conventional depot antipsychotic.
The two patient groups were demographically
similar. The RLAI group was 75% male, with an
average age of 41 years and 6.0 previous
psychiatric admissions. The conventional depot
group was 67% male, with an average age of 47.5
years and 5.9 previous psychiatric admissions. All
patients in each group were diagnosed with
schizophrenia. Antipsychotic polypharmacy was
reduced from 63% to 31% in the RLAI group but
increased from 29% to 73% in the conventional
depot group. The use of anticholinergic
side-effect medications decreased from 47% to 12%
in the risperidone RLAI group but increased from
31% to 73% in the conventional depot group. After
ten-months, 83% of the risperidone RLAI patients
had been discharged and none had been readmitted,
whereas only 58% of the conventional depot group
had been discharged with 26% having been
readmitted. CONLUSIONS:
In this
difficult-to-treat population of patients,
risperidone RLAI conferred significant advantages
over conventional depot antipsychotics in terms of
effectiveness and tolerability. As well, the
substantial differences in discharge and
readmission rates create considerable
pharmacoeconomic advantages in favor of RLAI.
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PMH12 |
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COST OF ANTIPSYCHOTIC POLY
PHARMACY IN THE TREATMENT OF SCHIZOPHRENIA
Zhu B1, Ascher-Svanum H1, Faries DE1,
Correll CU2, Kane JM2, 1Eli Lilly and Company,
Indianapolis, IN, USA, 2The Zucker Hillside
Hospital, Glen Oaks, NY, USA
OBJECTIVE:
To compare the cost of antipsychotic
polypharmacy during the treatment of schizophrenia
patients with risperidone, olanzapine, or
quetiapine. METHODS:
Data were drawn from a large
prospective naturalistic study of treatment for
schizophrenia in the United States, conducted
between 7/1997 and 9/2003. Participants who
initiated on risperidone (N=276), olanzapine
(N=405), or quetiapine (N=115) were followed for
1-year post initiation and compared on annual cost
of all antipsychotic medications, and on daily
cost of concomitant antipsychotic medication.
Statistical analysis used propensity score
adjusted bootstrap re-sampling methods. RESULTS:
Quetiapine-treated patients accrued significantly
higher annual cost of all antipsychotic
medications compared to olanzapine or risperidone
(p<.01). The daily cost of concomitant
antipsychotic medications was significantly higher
for quetiapine ($8.70) compared to olanzapine
($3.82, p<.01) or risperidonetreated patients
($4.30, p<.01). The total daily cost of
antipsychotics, including index antipsychotic
cost, was $15.33, $13.90, and $11.04 for
quetiapine, olanzapine and risperidone,
respectively. Each dollar spent on
quetiapine-treated patient was accompanied by
additional $1.31 on concomitant antipsychotic
medication, compared with $0.64 for risperidone,
and $0.38 for olanzapine-treated patients.
CONLUSIONS:
Prevalent antipsychotic polypharmacy
adds substantial cost to the treatment of
schizophrenia. A clearer understanding of the
concomitant antipsychotic costs provides a more
accurate portrayal of medication cost.
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PMH13 |
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VALUATION OF
SCHIZOPHRENIA-RELATED HEALTH STATES BY THE GENERAL
POPULATION USING THE ASSESSMENT OF QUALITY OF LIFE
QUESTIONNAIRE, TIME TRADE-OFF AND VISUAL ANALOGUE
SCALES
Adams J1, Le Reun C2, Crowley S3, Nand V4,
Eggleston A4, Schrover R5, 1Medical Technology
Assessment Group, Chatswood, NSW, Australia,
2M-TAG Pty Ltd, Chatswood, Australia, 3University
of Melbourne, North Ryde, NSW, Australia,
4Janssen-Cilag Pty Ltd, North Ryde, NSW,
Australia, 5Janssen-Cilag Pty Ltd/University of
Melbourne, North Ryde, NSW, Australia
OBJECTIVE:
To assess differences in the valuation
of eight schizophrenia-related health states using
a multi-attribute utility instrument, the
Assessment of Quality of Life Questionnaire (AQoL),
and two scaling techniques, the time trade-off (TTO)
and a visual analogue scale (VAS). METHODS:
Eight
schizophrenia-related health state scenarios based
on severity of symptoms and medication side
effects were presented to 87 participants from the
general population. Scenarios were: A) ‘good’
function with no movement disorders (extrapyramidal
symptoms); B) ‘good’ function with movement
disorders; C) ‘poor’ function with no movement
disorders; D) ‘poor’ function with movement
disorders; E) hospitalised relapse with no
movement disorders; F) hospitalised relapse with
movement disorders; G) post-hospitalisation with
no movement disorders; and H) post-hospitalisation
with movement disorders. Participants, once
educated about schizophrenia, were asked to value
each health state using the AQoL, TTO, and a VAS.
RESULTS:
Mean utility values for all health states
ranged from 0.62 to 0.05, 0.72 to 0.54 and 0.74 to
0.19 for the AQoL, TTO and VAS, respectively. For
each instrument or scale the rank order of utility
values was consistent with the severity of
symptoms, with more severe symptoms producing
lower scores. Patients experiencing EPS had lower
utility scores and hospitalisation also producing
utility decrements. There were differences between
the global results for AQoL, TTO and VAS (p<0.001,
Kruskal-Wallis test) and differences between the
utility measures for each health state, except
between the TTO and VAS results for health state A
(p=0.655), and the AQoL and VAS results for health
state G (p=0.094). CONLUSIONS:
Utility values
varied with severity of health state (symptoms)
and in most cases differed significantly between
instrument and/or scale. For schizophrenia, the
AQoL was most sensitive to differing symptom
severity, as assessed by the general population.
However, further research comparing the different
utility instruments is required in this disease
area. |
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PMH14 |
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ASSESSING THE HEALTH AND
ECONOMIC IMPACT OF SCHIZOPHRENIA ON CARERS: A
PILOT STUDY
Adams J1, Nand V2, Le Reun C3, Mudge M1, Crowley
S4, Eggleston A2, Schrover R5, Brown A1, 1Medical
Technology Assessment Group, Chatswood, NSW,
Australia, 2Janssen-Cilag Pty Ltd, North Ryde,
NSW, Australia, 3M-TAG Pty Ltd, Chatswood,
Australia, 4University of Melbourne, North Ryde,
NSW, Australia, 5Janssen-Cilag Pty Ltd/University
of Melbourne, North Ryde, NSW, Australia
OBJECTIVE:
To determine the direct and indirect
economic burden associated with caring for someone
with schizophrenia; carer quality of life using
Assessment of Quality of Life (AQoL) and carer
willingness-to-pay (WTP) and overall preference
for two schizophrenia treatments. METHODS:
Eight
schizophrenia-related health state scenarios were
presented to eight carers of patients with
schizophrenia. Scenarios were A) ‘good’ function
without extrapyramidal symptoms (EPS); B) ‘good’
function with EPS; C) ‘poor’ function without EPS;
D) ‘poor’ function with EPS; E) hospitalised due
to relapse without EPS; F) hospitalised due to
relapse with EPS; G) post hospitalisation without
EPS; and H) post hospitalisation with EPS. The
carers valued each health state using the AQoL and
the visual analogue scale (VAS) from the carer and
patient perspectives. Treatment preference and WTP
for two schizophrenia medicines (one long-acting
injection and one tablet) were evaluated using
contingent valuation (CV) and conjoint analysis
(CA). RESULTS:
On average, participants reported
caring for a person with schizophrenia for 15.3
hours/week. Mean costs incurred by carers included
non-prescription medication (AUD$21.67/week), food
($51.67/week), and travel expenses ($15.00/week).
The AQoL utility values from the carer and patient
perspectives ranged from 0.08–0.03, for health
state F, to 0.65 and 0.34, for health state A,
respectively. The VAS ratings from the patient
perspective for the same health states ranged from
0.44 to 0.10. The CA and the CV suggested a
preference for the injection-based treatment for
schizophrenia (WTP $242/month). CONLUSIONS:
The
results from this pilot study suggest that
schizophrenia is a costly illness. Furthermore,
the AQoL is sensitive to changes within
schizophrenia-related health states including
movement disorders. The results suggest that
carers prefer and are willing to pay for an
injection- based treatment. The results of the
pilot study were used to implement a larger-scale
survey of a more representative sample of carers. |
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PMH15 |
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PREFERENCE AND WILLINGNESS TO
PAY FOR THE TREATMENT OF SCHIZOPHRENIA FROM A
CARER’S PERSPECTIVE
Adams J1, Nand V2, LeReun C1, Crowley S3,
Eggleston A2, Schrover R4, Brown A1, 1Medical
Technology Assessment Group, Chatswood, NSW,
Australia, 2Janssen-Cilag Pty Ltd, North Ryde,
NSW, Australia, 3University of Melbourne, North
Ryde, NSW, Australia, 4Janssen-Cilag Pty
Ltd/University of Melbourne, North Ryde, NSW,
Australia OBJECTIVE:
To
determine carer preference and willingness to pay
(WTP) for a long-acting injection administered
fortnightly versus short-acting oral-based
treatment for schizophrenia. METHODS:
Carers of
people with schizophrenia were recruited through
the Schizophrenia Fellowship of New South Wales
and participants completed a mail out
questionnaire (n=73). All data were de-identified
and privacy regulations were adhered to. Treatment
preference and WTP for a fortnightly long-acting
injection versus oral-based treatment were
evaluated using discrete choice conjoint analysis
(CA). WTP was also valued with contingent
valuation (CV). Attributes in the WTP valuation
included route of administration, frequency of
relapse, frequency of extrapyramidal symptoms,
weight change and injection site reactions.
Responses deemed irrational were excluded from the
primary analyses. RESULTS:
The mean age of carers
was 61 years and the majority were females caring
for a son or daughter. Approximately 90% of
respondents returned rational responses. WTP with
CA was consistently higher than the WTP with CV.
The results from the WTP analyses showed that a
long-acting fortnightly injection-based treatment
was preferred over a short-acting tablet-based
treatment. The unadjusted incremental WTP from the
CA and CV for the long-acting injection-based
treatment over a short-acting oral medication were
AUD$322 per month and $155 per month,
respectively. The individual attributes driving
the overall WTP were explored. CONLUSIONS:
Overall, carers of people with schizophrenia
prefer and are willing to pay for an
injection-based treatment over a tablet-based
treatment. Reasons for the treatment preference
and willingness to pay for an injection-based
treatment include the perception that the
long-acting injection would improve patient
adherence with medication and the fact that the
treatment is administered by a nurse within the
public hospital or community setting.
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PMH17 |
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AGGREGATION OF RANKED
RESPONSES TO QUESTIONNAIRES EXPLORING QUALITY OF
LIFE
Lamure M, Auray JP, Duru G, Rico A, University
Lyons 1, Villeurbanne, France
OBJECTIVE:
To determine an aggregating process
based upon ordinal properties of scores computed
from QOL questionnaires. METHODS:
The method is
based on the Sugeno integral properties we recall
hereafter: “Let E be a compact subset of the set
of real numbers and N = {1, 2, 3,…,n-1, n}; 2N
denote the set of subsets of N. A capacity on N is
a mapping v(.) from 2N onto E which satisfies the
two following conditions: C1 : v(f) and v(N) are
respectively lower and upper elements of E, C2 :
for all subsets S and T of N, S included into T
implies v(S) £ v(T). Lastly, let f(.) be a mapping
from N onto E. Denoting by p(.) the permutation of
N such that f(p(1)) & pound;f(p(2)) & pound; …£
f(p(n)), the Sugeno integral of f(.) with respect
to v(.) is the real number defined as :ºfdv =
Max{min{f(font face=”Symbol”>p(j)),v({font
face=”Symbol” >p(j), font face=”Symbol” >p(j+1), …
, font face=”Symbol”>p(n)})} ; j=1, … ,n}”. We
focus on solving two problems: the one consisting
of aggregate the set of responses given to the
questions concerning a domain, the other
consisting of comparing two populations, for
instance patients before and after a treatment for
which one wants to evaluate effects on quality of
life. We also propose an analysis of the meaning
of v(.) in these two problems and a comparison of
the results obtained by our “Sugeno integral based
procedure” and those obtained by usual process.
RESULTS:
Our process is applied on data issued
from a questionnaire about QOL of French
teenagers. The obtained results are compared to
those obtained by classical procedures, in
particular to results obtained from
multidimensional methods. CONLUSIONS:
In this
paper, we demonstrate that it’s possible to define
operational processes for analyzing qualitative
data while respecting the qualitative nature of
these data. |
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