The Economic Burden of Schizophrenia in the United States in 2013

Cloutier, Martin; Aigbogun, Myrlene Sanon; Guérin, Annie; Nitulescu, Roy; Ramanakumar, Agnihotram V.; Kamat, Siddhesh; DeLucia, Michael; Duffy, Ruth A.; Legacy, Susan N.; Henderson, Crystal; François, Clément; Wu, Eric Q.

doi:10.4088/jcp.15m10278

Cited by 393 publications

(260 citation statements)

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“…In 2002, the US societal economic burden of schizophrenia was reported to be US$62.7 billion [3], becoming US$155.7 billion in 2013 [4]. Unemployment and productivity loss due to caregiving were the leading components of the incurred cost of the disease [4].…”

Section: Introductionmentioning

confidence: 99%

Adherence, Healthcare Resource Utilization, and Costs in Medicaid Beneficiaries with Schizophrenia Transitioning from Once-Monthly to Once-Every-3-Months Paliperidone Palmitate

Émond

Joshi

Khoury

et al. 2018

PharmacoEconomics Open

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Objectives The aim was to compare adherence to antipsychotics (APs), healthcare resource utilization (HRU), and costs before and after once-every-3-months paliperidone palmitate (PP3M) initiation in patients with schizophrenia. Methods Medicaid data (Iowa, Kansas, and Missouri; 1/2014-3/2017) were used to identify adults with at least one PP3M claim, ≥ 12 months of pre-index enrollment, and at least two schizophrenia diagnoses. Adequate treatment with once-monthly paliperidone palmitate (PP1M) was required pre-PP3M transition. Generalized estimating equations were used to assess linear trends in adherence to APs, HRU, and costs over the four quarters pre-PP3M transition, and to compare monthly HRU and costs 6 months pre-and 12 months post-PP3M transition as well as adherence to APs 12 months pre-and post-PP3M transition. Results Among 324 patients initiated on PP3M, the mean age was 41.4 years and 36.1% were females. Over the four quarters pre-PP3M transition, the monthly number of emergency room visits, medical costs, and inpatient costs decreased, while pharmacy costs and adherence to APs increased. For patients with ≥ 12 months of follow-up (n = 151), adherence to APs (66.2 vs. 70.2%, p = 0.3758), total (US$3371 vs. US$3456; p = 0.7000), pharmacy (US$1805 vs. US$1870; p = 0.2960), and medical costs (US$1565 vs. US$1586; p = 0.9040) remained similar pre-and post-PP3M transition, while mean monthly number of 1-day mental institute visits (1.71 vs. 1.51; p < 0.01) and associated costs (US$260 vs. US$232, p = 0.01) decreased. Conclusions Adherence to APs, HRU, and costs were similar pre-and post-PP3M transition, suggesting that PP3M has no impact on monthly costs for patients adequately treated with PP1M, with the added flexibility of once-every-3-months dosing. Key Points for Decision MakersOver the four quarters before once-every-3-months paliperidone palmitate (PP3M) transition, adherence to antipsychotics significantly improved and the increase in pharmacy costs was offset by decreasing medical costs, driven by a decrease in inpatient costs.Adherence to antipsychotics, monthly healthcare resource utilization, and monthly Medicaid spending remained similar before and after PP3M transition. These findings suggest that for patients adequately treated with once-monthly paliperidone palmitate, the transition to PP3M has no impact on monthly healthcare costs, with the added flexibility of once-every-3-months dosing.

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Section: Introductionmentioning

confidence: 99%

Adherence, Healthcare Resource Utilization, and Costs in Medicaid Beneficiaries with Schizophrenia Transitioning from Once-Monthly to Once-Every-3-Months Paliperidone Palmitate

Émond

Joshi

Khoury

et al. 2018

PharmacoEconomics Open

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“…Thus, it is important to have objective biomarkers to help implement treatment at an early stage. One estimate of the direct and indirect annual costs in the USA for SZ is USD 174 billion [88], with an additional cost of USD 151 billion for BD [89]. Biomarker signatures could lead to faster and more accurate diagnoses, reducing the duration of untreated psychosis, suicidality, and cognitive decline and adding to an understanding of the shared and unique pathophysiologies of each disorder.…”

Section: Discussionmentioning

confidence: 99%

Exon Array Biomarkers for the Differential Diagnosis of Schizophrenia and Bipolar Disorder

et al. 2017

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This study developed potential blood-based biomarker tests for diagnosing and differentiating schizophrenia (SZ), bipolar disorder type I (BD), and normal control (NC) subjects using mRNA gene expression signatures. A total of 90 subjects (n = 30 each for the three groups of subjects) provided blood samples at two visits. The Affymetrix exon microarray was used to profile the expression of over 1.4 million probesets. We selected potential biomarker panels using the temporal stability of the probesets and also back-tested them at two different visits for each subject. The 18-gene biomarker panels, using logistic regression modeling, correctly differentiated the three groups of subjects with high accuracy across the two different clinical visits (83–88% accuracy). The results are also consistent with the actual data and the “leave-one-out” analyses, indicating that the models should be predictive when applied to independent data cohorts. Many of the SZ and BD subjects were taking antipsychotic and mood stabilizer medications at the time of blood draw, raising the possibility that these drugs could have affected some of the differential transcription signatures. Using an independent Illumina data set of gene expression data from antipsychotic medication-free SZ subjects, the 18-gene biomarker panels produced a receiver operating characteristic curve accuracy greater than 0.866 in patients that were less than 30 years of age and medication free. We confirmed select transcripts by quantitative PCR and the nCounter® System. The episodic nature of psychiatric disorders might lead to highly variable results depending on when blood is collected in relation to the severity of the disease/symptoms. We have found stable trait gene panel markers for lifelong psychiatric disorders that may have diagnostic utility in younger undiagnosed subjects where there is a critical unmet need. The study requires replication in subjects for ultimate proof of the utility of the differential diagnosis.

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“…27 Only ~10%-15% of people who suffer from schizophrenia maintain full-time employment of any type. 28 Because the etiology of schizophrenia is unknown, the goals of treatment are to eliminate disease-related symptoms and to enhance functioning. The cornerstone of the current treatment is antipsychotic medication.…”

Section: Schizophreniamentioning

confidence: 99%

Novel Treatment Options in Depression and Psychosis

Češková

2017

Clinical Therapeutics

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Abstract:In spite of tremendous development in central nervous system research, current treatment is suboptimal, especially in severe mental disorders. In medicine, there are two main methods of improving the health care provided: seeking new treatment procedures and perfecting (optimizing) the existing ones. Optimization of treatment includes not only practical tools such as therapeutic drug monitoring but also implementation of general trends in the clinical practice. New pharmacological options include new more sophisticated forms of monoaminergic drugs, old drugs rediscovered on the base of a better understanding of pathophysiology of mental illnesses, and drugs aimed at new treatment targets. In depression, treatment resistance to antidepressive pharmacotherapy represents one of the most important clinical challenges. Switching to monotherapy with new multimodal/multifunctional antidepressants and augmentation with new atypical antipsychotics (aripiprazole and brexpiprazole) may be promising options. Further, current evidence supports utility and safety of adjunctive treatment of nutraceuticals. Novel approaches being studied include ketamine and opioids. Recent advances in technology and emerging knowledge about dysfunctional brain circuits and neuroplasticity have led to the development of different new neuromodulation techniques usually used as add-on therapy. Antipsychotics are still the cornerstone of the current treatment of schizophrenia. Two new partial dopamine agonists, brexpiprazole and cariprazine, are now available in addition to aripiprazole. Although the mechanisms of action are similar, the two agents differ in terms of their pharmacodynamic profiles. Further, two new formulations of long-acting injections of second-generation antipsychotics (aripiprazole lauroxil and 3-month paliperidone palmitate) were introduced into clinical practice. New treatment options not yet available include cannabidiol, glutamate modulators, and nicotine receptors agonists.

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The Economic Burden of Schizophrenia in the United States in 2013

Cited by 393 publications

References 0 publications

Adherence, Healthcare Resource Utilization, and Costs in Medicaid Beneficiaries with Schizophrenia Transitioning from Once-Monthly to Once-Every-3-Months Paliperidone Palmitate

Adherence, Healthcare Resource Utilization, and Costs in Medicaid Beneficiaries with Schizophrenia Transitioning from Once-Monthly to Once-Every-3-Months Paliperidone Palmitate

Exon Array Biomarkers for the Differential Diagnosis of Schizophrenia and Bipolar Disorder

Novel Treatment Options in Depression and Psychosis

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