Compliance, persistence, costs and quality of life in young patients treated with antipsychotic drugs: results from the COMETA study

Abstract

BackgroundLittle data is available on the real-world socio-economic burden and outcomes in schizophrenia. This study aimed to assess persistence, compliance, costs and Health-Related Quality-of-Life (HRQoL) in young patients undergoing antipsychotic treatment according to clinical practice.MethodsA naturalistic, longitudinal, multicentre cohort study was conducted: we involved 637 patients aged 18–40 years, with schizophrenia or schizophreniform disorder diagnosed ≤10 years before, enrolled in 86 Italian Mental Health Centres and followed-up for 1 year. Comparisons were conducted between naïve (i.e., patients visiting the centre for the first time and starting a new treatment regimen) and non naïve patients.ResultsAt enrolment, 84% of patients were taking atypical drugs, 3.7% typical, 10% a combination of the two classes, and 2% were untreated. During follow-up, 23% of patients switched at least once to a different class of treatment, a combination or no treatment. The mean Drug-Attitude-Inventory score was 43.4, with 94.3% of the patients considered compliant by the clinicians. On average, medical costs at baseline were 390.93€/patient-month, mostly for drug treatment (29.5%), psychotherapy (29.2%), and hospitalizations (27.1%). Patients and caregivers lost 3.5 days/patient-month of productivity. During follow-up, attitude toward treatment remained fairly similar, medical costs were generally stable, while productivity, clinical statusand HRQoL significantly improved. While no significantly different overall direct costs trends were found between naïve and non naïve patients, naïve patients showed generally a significant mean higher improvement of clinical outcomes, HRQoL and indirect costs, compared to the others.ConclusionsOur results suggest how tailoring the treatment strategy according to the complex and specific patient needs make it possible to achieve benefits and to allocate more efficiently resources. This study can also provide information on the most relevant items to be considered when conducting cost-effectiveness studies comparing specific alternatives for the treatment of target patients.

Economic Burden of Schizophrenia in Italy: A Probabilistic Cost of Illness Analysis

“…Costs may be due, for example, to, 'transportation to access treatment facilities and social care services'. 26 To estimate the burden related to this category, we considered the number of workdays that these subjects 10 spend in supporting the patients with schizophrenia . This value Open Access was multiplied by the Italian mean of income in 2014 35 to calculate the (crude) amount of the resources lost/used by these subjects.…”

“…8 As a consequence, indirect costs are a key aspect to estimate the overall impact of schizophrenia due to the precocity and chronic course of the illness, arising in most cases during adolescence. 10 Furthermore, it is fundamental to efficiently allocate the economic resources in the therapeutic area. Therefore, major aspects are also the administration of highly effective drugs and the continuity of treatment.…”

Approaches to improve adherence to pharmacotherapy in patients with schizophrenia

“…In a patient survey study that was conducted by nurses, the two most prominent barriers to medication adherence were stigma associated with taking medication and adverse drug reactions 2. Evidence also suggests that a variety of other factors may play a role in pharmacotherapy nonadherence among patients with schizophrenia, including the drug class prescribed (ie, typical versus atypical antipsychotics),3–5 drug formulation (ie, oral versus long-acting injectable [LAI] formulation),6 lack of adequate social support,7 lack of access to health care,8 and concurrent substance abuse 9. In patients with schizophrenia, nonadherence to prescribed medication is associated with symptom relapse, increased hospitalizations, and increased health care costs 10,11…”

Therapeutic continuity in the treatment of psychiatric disorders

“…Con una prevalenza di circa l'1,1% nella popolazione sopra i 18 anni di età, la schizofrenia costituisce una delle principali forme di psicosi (16). Negli Stati Uniti e in Europa, questo disturbo assorbe circa l'1,5-3% del budget sanitario complessivo; la prognosi funzionale sfavorevole della malattia determina inoltre alti costi indiretti (perdita di produttività) a carico della società (17). La schizofrenia costituisce l'ottava causa mondiale di disabilità, espressa in termini di disabilityadjusted life-years (DALY) nella popolazione compresa tra i 15 e i 34 anni di età (16).…”