The social and economic burden of treatment-resistant schizophrenia

Abstract

Patients with schizophrenia often fail to respond to an initial course of therapy. This study systematically reviewed the societal and economic burden of treatment-resistant schizophrenia (TRS). Studies that described patients with TRS published 1996-2012 were included if they collected primary data on clinical, social, or economic outcomes. All studies were independently reviewed and extracted by at least two investigators. Sixty-five studies were identified. Almost 60% (SD 18%) of patients failed to achieve response after 23 weeks on antipsychotic drug therapy. Patients with TRS had high rates of smoking (56%), alcohol abuse (51%), substance abuse (51%), and suicide ideation (44%). The incidence of severe adverse events to treatment was 4% (SD 7%). Mean quality of life for patients who were unresponsive or intolerant to treatment was ∼20% lower than that of patients in remission. Annual costs for patients with schizophrenia are $15 500-$22 300 and are 3-11-fold higher for patients with TRS. TRS remains common and costly, despite availability of many treatment options, and contributes to a significant loss in patient quality of life. Although estimates in the literature vary greatly, TRS conservatively adds more than $34 billion in annual direct medical costs in the USA.

Does Half-Life Matter After Antipsychotic Discontinuation?

“…1,2 Relapse is at best disruptive 2 ; at worst, it can be lethal. 3 Studies show that relapse has a multitude of negative consequences to a person's physiologic, psychological, and social well-being. [1][2][3] Ideally, patients with schizophrenia should receive continuous antipsychotic maintenance therapy, an approach widely recognized as an important strategy for delaying relapse.…”

“…3 Studies show that relapse has a multitude of negative consequences to a person's physiologic, psychological, and social well-being. [1][2][3] Ideally, patients with schizophrenia should receive continuous antipsychotic maintenance therapy, an approach widely recognized as an important strategy for delaying relapse. [4][5][6][7] When this is not possible, symptom-targeted and intermittent antipsychotic administration strategies have been used, but are associated with unacceptable increases in relapse risk and are therefore not recommended.…”

Prescribing trends in treatment-resistant schizophrenia

“…Treatment-resistant schizophrenia (TRS) puts a significant burden on patients' wellbeing. A recent review found decreased quality of life, increased medical costs, and increased rates of serious comorbidities compared with patients with schizophrenia in general [3].…”

A Clinical Case of Treatment-Resistant Schizophrenia: 60 Hospitalizations and 342 Ect Sessions in 36 Years; Lack of Social Support or Undertreatment?

“…TRS remains common and expensive, despite availability of many treatment options, and contributes to a significant loss in patient's quality of life. Although estimates in the literature vary greatly, TRS has huge medical costs 4,5 .…”