Healthcare resource use in schizophrenia, EuroSC findings

A Millier,M Horváth,F Ma,K Kóczián,A Götze,M Toumi

doi:10.1080/20016689.2017.1372027

Abstract

ABSTRACTBackground: It is unclear if the burden associated with schizophrenia is affected by the type and severity of patient’s symptoms.Objective: This study aims to quantify healthcare resource use associated with different profiles of schizophrenia symptoms.Study design: Post-hoc analysis of data from a naturalistic follow-up study.Setting: Secondary psychiatric services in France, Germany and the UK.Patients: EuroSC cohort:, representative sample of 1,208 schizophrenia patientsMain outcome measure: We classified patients into eight health states, according to the Lenert classification (HS1–HS8), and estimated 6-month healthcare resource use (outpatient and day clinic visits, and hospitalisations) across the health states.Results: Approximately half of the patients were classed as having mild symptoms (HS1), with around 20% experiencing moderate, predominantly negative symptoms (HS2). The remaining health states were represented by <10% of patients each. Very few patients experienced extremely severe symptoms (HS8). No health state was associated with excess utilisation across all resource types. In terms of outpatient visits, patients were estimated to see a psychiatrist most often (3.01–4.15 visits over 6 months). Hospital admission was needed in 11%(HS1) – 35%(HS8) of patients and inpatient stays were generally prolonged for all health states (39–57 days). The average number of inpatient days was highest for patients in HS8 (18.17 days), followed by patients with severe negative symptoms (HS4; 13.37 days). In other health states characterised by severe symptoms (HS5–HS7), the average number of inpatient days was approximately half of those seen for HS4 (6.09–7.66).Conclusion: While none of the symptom profiles was associated with excess resource usage, hospitalization days were highest for HS with severe, predominantly negative or extremely severe symptoms. Patients with predominantly negative, moderate or severe symptoms appeared to have a high number of psychologist visits – an interesting finding that may reflect a specific therapeutic approach to the treatment of these patients.

Highlights

It is unclear if the burden associated with schizophrenia is affected by the type and severity of patient’s symptoms
Resource use in the European Schizophrenia Cohort (EuroSC) cohort was estimated from the raw data (Supplementary Table 1) using the twopart statistical model described in the methods
We studied the EuroSC cohort, a representative sample of schizophrenia patients from three European countries, which has been extensively used in prior research on this debilitating disease [15,16,17,18,19,20,21,22,23,24,25] Within this cohort, up to a third of patients were in HS2 or HS4 and experienced predominantly negative symptoms that were classed as moderate or severe, in line with earlier studies suggesting that negative symptoms of schizophrenia are very common

Summary

Introduction

It is unclear if the burden associated with schizophrenia is affected by the type and severity of patient’s symptoms. Objective: This study aims to quantify healthcare resource use associated with different profiles of schizophrenia symptoms. Are usually classed as positive (i.e. those that occur in patients with schizophrenia but not in unaffected individuals) and negative (i.e. those that are lacking in people affected by the disease, but are commonly found in others) [7]. Examples of positive symptoms include hallucinations and delusions, while social withdrawal, lack of motivation and diminished emotional reactivity are considered negative symptoms [8]. Schizophrenia is often associated with cognitive deficits that may affect functions such as working memory and attention [8]

Objectives

Methods

Results

Discussion

Conclusion