Abstract
The impact of initiatives aimed at reducing time in untreated psychosis during early-stage schizophrenia will be unknown for many years. Thus, we simulate the effect of earlier treatment entry and better antipsychotic drug adherence on schizophrenia-related hospitalizations, receipt of disability benefits, competitive employment, and independent/family living over a ten-year horizon. We predict that earlier treatment entry reduces hospitalizations by 12.6–14.4% and benefit receipt by 7.0–8.5%, while increasing independent/family living by 41.5–46% and employment by 42–58%. We predict larger gains if a pro-adherence intervention is also used. Our findings suggest substantial benefits of timely and consistent early schizophrenia care.
Highlights
Schizophrenia is a devastating mental illness that affects cognitive functioning and manifests through “positive” psychotic symptoms such as paranoid delusions, and “negative” symptoms such as apathy (Weinberger and Harrison 2011)
The proportion of patients who receive disability benefits at the beginning of the chronic phase (Panel B) is estimated to decline from 71%, assuming the long DUP observed in U.S community clinics, to 66% and 65% if the shorter DUPs observed in the multinational cohort and Dutch RCT were the norm, corresponding to relative reductions of 7.0% and 8.5%, respectively
While approximately two out of five patients (41%) are predicted to live independently or with family 10 years after onset of psychosis assuming the long DUP observed in U.S community clinics, the proportion would be higher, around three out of five, if the shorter DUPs observed in the multinational cohorts (60%) and the Dutch RCT (58%) were the norm (Panel C)
Summary
Schizophrenia is a devastating mental illness that affects cognitive functioning and manifests through “positive” psychotic symptoms such as paranoid delusions, and “negative” symptoms such as apathy (Weinberger and Harrison 2011). It has a disproportionately large burden of disease partly due Aspects of this paper were presented in a poster titled “The Long-Term Benefits of Ensuring Timely Treatment and Improved Medication Adherence in Early Schizophrenia: A Microsimulation Study” at the ISPOR 23d Annual International Meeting in Baltimore, MD, USA. The illness exacts high costs to society, estimated at $155.7 billion for the U.S in 2013, with excess healthcare costs and costs associated with unemployment accounting for 24% and 38%, respectively, of the overall costs (Cloutier et al 2016)
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