Evaluation of the Cost-effectiveness of Services for Schizophrenia in the UK Across the Entire Care Pathway in a Single Whole-Disease Model

Abstract

IMPORTANCE The existing economic models for schizophrenia often have 3 limitations; namely, they do not cover nonpharmacologic interventions, they report inconsistent conclusions for antipsychotics, and they have poor methodologic quality. OBJECTIVES To develop a whole-disease model for schizophrenia and use it to inform resource allocation decisions across the entire care pathway for schizophrenia in the UK. DESIGN, SETTING, AND PARTICIPANTS This decision analytical model used a whole-disease model to simulate the entire disease and treatment pathway among a simulated cohort of 200 000 individuals at clinical high risk of psychoses or with a diagnosis of psychosis or schizophrenia being treated in primary, secondary, and tertiary care in the UK.

Cost and health impacts of adherence to the National Institute for Health and Care Excellence schizophrenia guideline recommendations

“…All data generated or analysed during this study are included in this published article and a previous publication about the methods of developing the schizophrenia whole-disease model. 7 Author contributions H.J. conducted the economic analysis, including adapting the existing schizophrenia for this study, searching for and preparing input data, running the computer model and analysing the results.…”

“…After managing relapse, those patients will either return to their previous antipsychotic medication, if this is the first time that they discontinue an oral antipsychotic medication because of non-adherence, or be switched to a long-acting injectable antipsychotic medication, if they have discontinued oral antipsychotic medications more than once. A comprehensive description of the model structure is reported by Jin et al 7…”

“…A list of input data for the schizophrenia WDM is reported in a previous publication. 7 The key parameters that are most relevant to this study are reported in Supplementary Table 2; these are briefly summarised below. The current provision of CBT and family intervention were obtained from the Early intervention in Psychosis national audit, 2 which analysed data submitted by 55 mental health providers in England.…”

Stationsäquivalente Behandlung

“…B. Entgeltgruppe 9), verzichten aber gleichzeitig auf Nachtdienstzuschläge, wenn sie vollständig in der StäB arbeiten. Eine detaillierte und valide ökonomische Gesamtbewertung von StäB an sich und umso mehr gerontopsychiatrischer StäB steht aufgrund der Vielzahl von ökonomischen Einflussfaktoren, aber auch der Akzeptanz [ 14 ] der Behandlungsform durch Kranken- und Pflegekassen, Patienten, Angehörige und Pflegeeinrichtungen noch aus [ 15 ] Modellprojekte beziehen sich insbesondere auf schizophrene Krankheitsbilder [ 16 , 17 ] und fokussieren mehr inhaltliche als ökonomische Vorteile [ 18 ]; neueste angloamerikanische Forschung weist hier auf eine Kosteneffizienz unter Berechnung der lebensqualitätsadjustierten Lebensjahre (QUALY) hin [ 19 ]. Diese Studie weist aber auch auf die Herausforderung einer solchen Evaluation hin, in der neben den akuten Effekten wie Behandlungsdauer auch langfristige Evaluation von QUALY, Wiederaufnahmen, Pflegeaufwand, Autonomie, Demenzentwicklung, Belastung pflegender Angehöriger etc.…”

‘Opening doors’ for long‐term institutionalised patients with schizophrenia in Japan

“…Furthermore, many medical economic studies have demonstrated that clozapine is superior for treating patients with TRS and is more cost-effective than other antipsychotics. 3 Long-term administration of clozapine can help reduce the number of admissions and length of hospital stay, leading to decreased medical costs. However, the clozapine administration rate in Japan is 0.6 per 100,000 persons, which is substantially lower than that in other countries (41.8-189.2 per 100,000 persons).…”