Schizophrenia In Spain Research Articles

Clinical Experience on the Use of a Single-day, Two-injection Start Initiation Regimen of Aripiprazole Once Monthly in Patients With Schizophrenia in Spain: SaTISfy Study.

The two-injection start (TIS) initiation regimen was recently approved for aripiprazole once monthly 400mg (AOM400), with potential benefits in adherence. The SaTISfy study described in this article analyzed Spanish psychiatrists' perspectives on hospitalization lengths of stay, schizophrenia management, and the use of AOM400-TIS. The authors describe an ecological study of aggregated data collected using a 41-question survey. Fifty psychiatrists were asked to provide their perceptions of their patients with schizophrenia and treatment with AOM400. The psychiatrists reported that lack of treatment adherence was the main reason for hospitalization for 58.3% of their patients diagnosed with schizophrenia. Aripiprazole, in any formulation, was the most commonly prescribed therapeutic option, being prescribed for a mean (SD) of 2.5 (0.9) out of 5 patients, while 98% of psychiatrists chose AOM400-TIS for patients who failed to adhere to previous treatments. Patients with schizophrenia, regardless of their treatment, were hospitalized for an average of 17.7 (3.93) days versus patients with schizophrenia treated with AOM400-TIS, who were hospitalized for an average of 14.2 (4.18) days, a reduction of 3.5 (3.86) days. Patients treated with AOM400-TIS showed a reduction of 5 (4.18) days compared with the mean national duration of hospitalization for acute patients in psychiatry units in Spain (19.18d). The surveyed psychiatrists reported that AOM400-TIS improved safety and tolerability. Most of the psychiatrists were satisfied with the administration and results of AOM400-TIS. Most of the psychiatrists (90%) also reported that fewer health care resources were consumed with AOM400-TIS, mainly due to a reduction in hospitalization days and in the use of concomitant medications. AOM400-TIS was considered to have a positive impact on the duration of hospitalization and thus on the use of health care resources. There was a positive perception of adherence, safety, and tolerability with the use of AOM400-TIS in patients with schizophrenia.

EE398 Budget Impact Analysis of Lurasidone in the Treatment of Adult and Adolescent Patients With Schizophrenia in Spain

Although atypical antipsychotics (AA) are the first-line treatments for patients with schizophrenia, for those aged 13-14 years, lurasidone is the only AA licensed. Besides, some AA are related with cardiometabolic events (CME) and lack adherence, generating significant clinical and economic consequences. The aim of this study is to estimate the budget impact (BI) of lurasidone in the management of adult and adolescent (13-17 years) patients with schizophrenia in Spain from a payer's perspective over a 3-years’ time horizon.

Patient-reported impact of symptoms in schizophrenia scale (PRISS): Development and validation.

We report the psychometric properties of the Patient-Reported Impact of Symptoms in Schizophrenia Scale (PRISS), which assesses the impact of subjective experiences or qualia in outpatients with this condition. A cross-sectional study was carried out in 162 patients diagnosed with schizophrenia in Spain. The PRISS measures the presence, frequency, concern and interference with daily life of self-reported experiences related to the main symptoms observed in these patients. The psychometric analysis included test-retest reliability, internal consistency and structural and convergent validity. The 28-item PRISS showed good test-retest reliability as 64.3% of the intraclass correlation coefficient values were between 0.40 and 0.79, which were statistically significant (p<0.01). Analysis of the structural validity revealed a three-factor structure, (1) productive subjective experiences, (2) affective-negative subjective experiences and (3) excitation, which accounted for 56.11% of the variance. Of the Pearson's correlation coefficients analysed between the PRISS and the Positive and Negative Syndrome Scale (PANSS), Scale for Assessment of Negative Symptoms (SANS) and World Health Organization Disability Assessment Schedule (WHO-DAS), 72.2% were statistically significant (p<0.05) and ranged from 0.38-0.42, 0.32-0.42 and 0.40-0.42, respectively. Our results indicate that the PRISS appears to be a brief, reliable and valid scale to measure subjective experiences in schizophrenia and provides valuable information complementary to clinical evaluation.

POSA41 Budget Impact Analysis of Lurasidone in the Treatment of Adult Patients with Schizophrenia in Spain

Atypical antipsychotics are first choice treatment for patients with schizophrenia. However, some of them are associated with cardiometabolic events (CME) and non-adherence to the medication, resulting in a significant clinical and economic impact. The aim of this study is to evaluate the budget impact (BI) of lurasidone in the management of adult patients with schizophrenia in Spain from a payer's perspective over a three-years’ time horizon.

PMH41 THE REAL WORLD USE OF ORAL ANTIPSYCHOTICS IN SPAIN-STILL A NEED FOR NEW TREATMENTS?

Patients with schizophrenia receive multiple treatments along the course of their chronic disease. Several guidelines recommend to consider an alternative treatment if current one does not provide the expected efficacy. The “ideal” treatment controls both positive and negative symptoms and preserves patient’s functionality. First and second generation antipsychotics have different dopaminergic, serotoninergic or adrenergic receptor activities and affinities. They are equally recommended but neither of them seem to cover “ideal” criteria fully, which added to potential side effects, may led to a non-adherence-related risk of relapse. The Spanish market of oral antipsychotics has not changed in the past years. The objective of this study was to analyze the real use of oral antipsychotics in Spain and to interpret data from the clinical point of view. Analysis of oral antipsychotics prescription patterns in Spain by means of a representative sample of patients with schizophrenia from a Spanish Longitudinal IQVIA Patient Data base of two consecutive years (2016 and 2017) from 935 psychiatric sites. The mean percentage of use for second-generation antipsychotics was 93.43% while first generation 6.57%. Among the demographical and epidemiological-calculated 207,313 patients under second-generation of oral antipsychotics, the actual pattern of use was olanzapine 33.65 %, quetiapine 16.70 %, aripiprazole 14.34%, paliperidone 13.68 %, risperidone 10.67 %, clozapine 4.84 %, amisulpride 3.10 %, ziprasidone 2.83 %. A high and widespread use of second-generation oral antipsychotics is observed in the population diagnosed with schizophrenia in Spain. Prescription preferences (>80%) was predominantly using “pines” (olanzapine/quetiapine), “dones” (paliperidone/risperidone) or aripiprazole (the only dopaminergic partial agonist). This wide use could be due to the apparent need of different antipsychotics with different mechanisms of action able to adapt to patient’s characteristics. In an unchanged market for more than 10 years, it is also probable that new antipsychotics are still needed.

Digital Technology for Internet Access by Patients With Early-Stage Schizophrenia in Spain: Multicenter Research Study.

BackgroundDigital technology and social networks are part of everyday life in the current internet age, especially among young people. To date, few studies have been published worldwide on the pattern of use of digital technology devices and applications in patients with early-stage schizophrenia and even fewer comparing them with healthy participants (not using data from general population surveys) from the same demographic areas. In Spain, no such study has been carried out.ObjectiveThe aim of this study was to analyze how patients with early-stage schizophrenia use internet and social networks compared with healthy participants matched by age and gender and also to examine which devices are utilized to access internet resources.MethodsA cross-sectional, multicentric study was carried out through a semistructured interview asking about the use of digital technology devices and internet. The sample comprised 90 patients and 90 healthy participants. The semistructured interview was conducted on 30 outpatients and 30 healthy subjects in each of the 3 different cities (Madrid, Alicante, and Cuenca). Student t test was used for continuous variables and chi-square test for categorical variables. In the case of ordinal variables, nonparametric Mann-Whitney U and Kruskal-Wallis H tests for independent samples were performed to compare groups.ResultsThe results indicated that a large proportion of patients with early-stage schizophrenia have access to different digital devices and use them frequently. In addition, both groups coincide in the order of preference and the purpose for which they use the devices. However, a lower frequency of use of most digital technology devices was detected in patients compared with healthy participants. In the case of some devices, this was due to the impossibility of access and not a lack of interest.ConclusionsTo our knowledge, this is the first study to analyze patterns of internet access and use of digital technology devices and applications in Spanish patients with early-stage schizophrenia compared with healthy participants from the same demographic areas. The results on significant access and use of digital technology and internet shown in this cross-sectional study will allow enhanced and more efficient treatment strategies to be planned, utilizing digital technology devices, for patients with early-stage schizophrenia.

Long-acting injectable antipsychotics for the treatment of schizophrenia in Spain

Antipsychotics are an essential component in the treatment of schizophrenia. Long-acting injectable formulations (LAI) arose to improve adherence with the associated potential of reducing the risk of relapse. The objective of this article is to analyse the use of LAI antipsychotics in Spain, which is similar to other European countries but with a predominance of the use of second generation LAI, to discuss the possible causes of prescribing differences with respect to other countries (including organisational aspects, attitudes of psychiatrists, patients and family members, and clinical practice guidelines), and to discuss their use in acute psychiatric units, first episode, and in children and adolescents. In our view, while it is necessary to increase existing evidence regarding the advantages of LAI antipsychotics and the differentiation between LAI antipsychotics currently available, their use will likely continue to grow driven by clinical experience.

Long-acting injectable antipsychotics for the treatment of schizophrenia in Spain.

Antipsychotics are an essential component in the treatment of schizophrenia. Long-acting injectable formulations (LAI) arose to improve adherence with the associated potential of reducing the risk of relapse. The objective of this article is to analyze the use of LAI antipsychotics in Spain, which is similar to other European countries but with a predominance of the use of second generation LAI, to discuss the possible causes of prescribing differences with respect to other countries (including organizational aspects, attitudes of psychiatrists, patients and family members, and clinical practice guidelines), and to discuss their use in acute psychiatric units, first episode, and in children and adolescents. In our view, while it is necessary to increase existing evidence regarding the advantages of LAI antipsychotics and the differentiation between LAI antipsychotics currently available, their use will likely continue to grow driven by clinical experience.

Cost-effectiveness of 3-month paliperidone treatment for chronic schizophrenia in Spain

Background: A 3-month long treatment of paliperidone palmitate (PP3M) has been introduced as an option for treating schizophrenia. Its cost-effectiveness in Spain has not been established.Aims: To compare the costs and effects of PP3M compared with once-monthly paliperidone (PP1M) from the payer perspective in Spain.Methods: This study used the recently published trial by Savitz et al. as a core model over 1 year. Additional data were derived from the literature. Costs in 2016 Euros were obtained from official lists and utilities from Osborne et al. The authors conducted both cost-utility and cost-effectiveness analyses. For the former, the incremental cost per quality-adjusted life-year (QALY) gained was calculated. For the latter, the outcomes were relapses and hospitalizations avoided. To assure the robustness of the analyses, a series of 1-way and probability sensitivity analyses were conducted.Results: The expected cost was lower with PP3M (4,780€) compared with PP1M (5,244€). PP3M had the fewest relapses (0.080 vs 0.161), hospitalizations (0.034 v.s 0.065), and emergency room visits (0.045 v.s 0.096) and the most QALYs (0.677 v.s 0.625). In both cost-effectiveness and cost-utility analyses, PP3M dominated PP1M. Sensitivity analyses confirmed base case findings. For the primary analysis (cost-utility), PP3M dominated PP1M in 46.9% of 10,000 simulations and was cost-effective at a threshold of 30,000€/QALY gained.Conclusions: PP3M dominated PP1M in all analyses and was, therefore, cost-effective for treating chronic relapsing schizophrenia in Spain. For patients who require long-acting therapy, PP3M appears to be a good alternative anti-psychotic treatment.

PMD52 - Potential Cost Savings of A Point-Of-Care Diagnostic Test Measuring Antipsychotic Plasma Levels for Treatment of Patients with Schizophrenia in Spain

PMD52 - Potential Cost Savings of A Point-Of-Care Diagnostic Test Measuring Antipsychotic Plasma Levels for Treatment of Patients with Schizophrenia in Spain

Long-acting paliperidone cost saving for schizophrenia in Spain

Long-acting paliperidone cost saving for schizophrenia in Spain

Hospital admissions and direct costs: A comparative study between paliperidone palmitate and oral antipsychotics

IntroductionThe total costs of schizophrenia increased to 2576 million Euros in 2013 in Spain, or 2.7% of the annual cost of health services. The hospitalizations, along with other intermediate resources, such as Day Hospital, etc., significantly contribute to the increase of economic burden. In Spain, the average hospital stay of schizophrenic patients is 18.24 days, totalling to an average cost of 6,753 Euros/patient (370.23 Euros/patient/day).Material and methodsThe sample selected included patients from both sexes, aged between 18 and 65 years old, with diagnostic criteria of schizophrenia (according to DSM-IV and ICD-10), admitted in the Mental Health Hospital Unit (MHHU), Úbeda between 2012 and 2013, with registered visits of at least 2 outpatient visits or 1 hospitalization related to the schizophrenia diagnosis (n = 48).ResultsAfter the start of treatment with the injectable antipsychotic drug of prolonged duration, the number of patients that required hospitalization for any psychiatric motive went from 24 patients (49.7%) to 11 patients (22.4%; P &lt; 0.001). The patients who started treatment with PAP during hospitalization had an average stay of 15.7 days, as compared to 18.24 days of average hospital stay due to schizophrenia in Spain. The direct costs of hospitalization stays due to psychiatric reasons decreased from 162,071.88 Euros to 74,282.95 Euros (P &lt; 0.001).ConclusionsThis observational study shows us that the treatment with PAP reduced the average length of the hospital stay, and resulted in a decreased percentage of re-admissions as compared to oral treatments for schizophrenia. These data led to savings of more than 50% of the direct costs of hospitalization.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The cost-effectiveness of paliperidone extended release in Spain

Background:Paliperidone Extended Release OROS (ER) is a new atypical antipsychotic for the treatment of schizophrenia. The objective is, based on a previously published model, to analyze the clinical and economic effects of Paliperidone ER in a Spanish setting compared to olanzapine oral and aripiprazole.Methods:An existing discrete event simulation model was adapted to reflect the treatment of schizophrenia in Spain in terms of costs, resource use, and treatment patterns. Inputs for the model were derived from clinical trial data, literature research, database analysis and interviews with local clinical experts. The time horizon is 5 years and Spanish discount rate was applied. Outputs include direct medical costs and Quality Adjusted Life-Years (QALYs). Extensive sensitivity analyses were carried out to assess the robustness of the results, using ordinary least squares analysis and cost-effectiveness scatter plots.Results:The results show that the mean incremental QALYs (95% CI) compared to olanzpine is 0.033 [−0.143, 0.304] and compared to aripiprazole 0.029 [−0.107, 0.300]. The corresponding mean incremental costs and corresponding confidence intervals are −€1425 [−€10,247, €3084] and −€759 [−€10,479, €3404], respectively. The probability that paliperidone ER is cost-saving and health gaining compared to olanzapine and aripiprazole is 76% and 72%, respectively. Paliperidone ER was estimated to have 80% and 81% probability of being cost-effective compared to olanzapine at a willingness to pay of €20,000 and €30,000 and 73% and 74% compared to aripiprazole, respectively.Limitations:Some of the modeled inter-relationships had to be based on expert opinion due to a lack of information. Also, foreign sources for the disutility of adverse events had been used due to a lack of Spanish data. Prolactin-related side-effects, indirect costs, and potential compliance advantages of paliperidone ER were not considered. It is unlikely that these limitations affected the conclusions.Conclusion:Based on differences in drug acquisition costs, side-effects, and risk of relapse, the model predicts that, in the Spanish healthcare setting, paliperidone ER dominates oral olanzapine and aripiprazole, with a probability of 76% and 72%, respectively.

P-1273 - Short message service to improve treatment adherence and quality of life in patients with schizophrenia in spain: the SMS study

Schizophrenia is a very incapacitating mental diseases. A lack of pharmacological adherence drives to an increased relapse and hospitalizations incidence. Strategies focused on improving adherence could benefit patients and improve their quality of life (QoL). To assess improvements on QoL by increasing treatment adherence. This was a national, multicentre, open-label randomized clinical trial to evaluate the efficacy of a Short Message Service (SMS) system on improving adherence in schizophrenic patients. Patients in the SMS group received reminders via mobile phone about their medication during the first 3 months after inclusion. Controls were not sent any reminder and received standard care. Adherence was assessed by mean of the 4-item Morisky-Green test (Medication Adherence Questionnaire, MAQ) and attitude towards medication was assessed by the 10-Item Drug Attitude Inventory (DAI-10) at baseline and 3 and 6 months after the inclusion. QoL was assessed by the EuroQol (EQ-5D) questionnaire at the same visits. Based on Intention To Treat (ITT) population, 100 (39.4%) patients comprised the SMS Group, whereas 154 (60.6%) patients were controls. There were not statistically significant differences on demographic characteristics between both groups. More patients improved their adherence (MAQ) in SMS group compared to the control group [44.0% vs. 28.6% (p = 0.012)]. No significant differences were found regarding attitude towards medication (DAI-10), however improvements in DAI-10 were associated with improvements in EQ-5D [82.5% vs. 64.9% (p = 0.029)]. SMS reminders improved adherence to treatment and improved patients’ outcomes with a positive impact on QoL.

PMH33 The Cost-Effectiveness of Paliperidone ER in Spain

Paliperidone ER Extended Release OROS (ER) is a relatively new atypical antipsychotic for the treatment of schizophrenia. The objective is, based on a previously published model, to analyze the clinical and economic effects of Paliperidone ER in Spain compared to olanzapine oral and aripiprazole. An existing discrete event simulation model was adapted to reflect the treatment of schizophrenia in Spain in terms of costs, resource use and treatment patterns. Inputs for the model were derived from clinical trial data, literature search, database analysis, and interviews with local clinical experts. The time horizon is five years and Spanish discount rates were applied. Outputs included direct medical costs and Quality Adjusted Life-Years (QALYs). Sensitivity analyses were conducted to assess the uncertainty surrounding incremental outcomes and to identify model drivers, by performing probabilistic sensitivity analysis (PSA) and ordinary least squares analysis (OLSA). The mean (95% CI) incremental QALYs compared to olanzapine is 0.033 [-0.14, 0.30] and compared to aripiprazole 0.029 [-0.11,0.30]. The corresponding mean incremental costs (95% CI) are -€ 1,425 [-€ 10,247, €3,084] and -€ 759 [-€ 10,479, € 3,404] respectively. Based on the PSA, the probability that paliperidone ER is cost-saving and improves QALYs compared to olanzapine and aripiprazole is 76% and 72% respectively. Paliperidone ER was estimated to have 80% and 81% probability of being cost effective compared to olanzapine at a willingness to pay of €20,000 and €30,000 and 73% and 74% compared to aripiprazole respectively. OLSA identified drug acquisition costs, side effects and risk of relapse to be major model drivers. Based on differences in drug acquisition costs, side effects and risk of relapse, the model predicts that in Spain paliperidone ER provides QALY gains and cost savings compared with oral olanzapine and aripiprazole with a probability of 76% and 72% respectively.

PMH31 Cost-Effectiveness of Long-Acting Olanzapine Versus Long-Acting Risperidone in Patients with Schizophrenia in Spain

PMH31 Cost-Effectiveness of Long-Acting Olanzapine Versus Long-Acting Risperidone in Patients with Schizophrenia in Spain

Physical disease in schizophrenia: a population-based analysis in Spain

BackgroundPhysical disease remains a challenge in patients with schizophrenia. Our objective was to determine the epidemiological characteristics and burden of physical disease in hospitalized patients with schizophrenia.MethodsWe analyzed the 2004 Spanish National Hospital Discharge Registry, identified records coded for schizophrenia (295.xx) and characterized the physical diseases using the ICD-9 system and the Charlson Index. We also calculated standardized mortality ratios (SMRs) versus the general population adjusted by age and calendar time.ResultsA total of 16, 776 cases (mean age: 43 years, 65% males) were considered for analysis. Overall, 61% of cases had at least one ICD-9 physical code and 32% had more than one ICD-9 code. The Charlson index indicated that 20% of cases had a physical disease of known clinical impact and prognostic significance. Physical disease appeared early in life (50% of cases were 15-31 years of age) and increased rapidly in incidence with age. Thus, for patients aged 53 years or more, 84% had at least one physical ICD-9 code. Apart from substance abuse and addiction, the most prevalent diseases were endocrine (16%), circulatory (15%), respiratory (15%), injury-poisoning (11%), and digestive (10%). There were gender-related differences in disease burden and type of disease. In-hospital mortality significantly correlated with age, the Charlson Index and several ICD-9 groups of physical disease. Physical disease was associated with an overall 3.6-fold increase in SMRs compared with the general population.ConclusionsThis study provides the first nationally representative estimate of the prevalence and characteristics of physical disease in hospitalized patients with schizophrenia in Spain. Our results indicate that schizophrenia is associated with a substantial burden of physical comorbidities; that these comorbidities appear early in life; and that they have a substantial impact on mortality. This information raises concerns about the consequences and causes of physical disorders in patients with schizophrenia. Additionally, it will help to guide the design and implementation of preventive and therapeutic programs from the viewpoint of clinical care and in terms of health-care service planning.

PW01-104 - Factors associated to use of ambulatory public mental health services among patients with schizophrenia in Spain. Case register study: RESMA

ObjectiveTo identify factors associated with visits by patients with schizophrenia and related disorders to community mental health services, under the Mental Health Department of Carlos Haya Hospital in Malaga, Spain.MethodsWe undertook a cross-sectional study. Data on demographic and clinical factors and service use were obtained from the public mental health services database and centralized in the “Malaga Schizophrenia Case Register (RESMA)”. The outcome measure, defined as the total number of outpatient consultations during one year, was analyzed by multilevel multivariate linear regression.ResultsThe analysis included 1097 patients with diagnoses of schizophrenia and related disorders (F20-F29, ICD-10).The adjusted model explained 46.35% of the variance. Patients who contacted both types of professional (nurses and psychiatrists) had a higher number of visits compared to patients who only contacted a psychiatrist (p&lt; 0.001), and the individual psychiatrist attending the patients was also associated with the number of visits (p&lt; 0.001).Clinical variables, such as a higher global level of severity (p&lt; 0.001), a diagnosis of a persistent delusion disorder and having an inpatient episode (p&lt; 0.001), were also associated with a higher number of visits. Patients who were receiving welfare benefits or who had no formal education or were illiterate had a higher number of visits. Patients living alone, living outside the study area and living in more rural municipalities was associated with fewer ambulatory contacts.ConclusionAmong all variables, the role of psychiatrists and nurses in organized outpatient settings present the strongest association with the number of visits by similar patients.

Community-Level Correlates of Hospitalizations for Persons With Schizophrenia

Community-Level Correlates of Hospitalizations for Persons With Schizophrenia

Observational study of patients with schizophrenia in Spain: ACE 2005 study

Aims:Epidemiological study of schizophrenia in Spain with a focus on clinical, diagnostic and treatment trends along the year 2005 compared with those observed in ACE 2004 study;Methods:617 psychiatrists from public and private Spanish clinics registered the first four patients with schizophrenia seen at their offices.Results:A total of 2,430 patients were entered in the study (70% males, 79% unmarried; median age, 37 years) of which, 1,113 had participated in the ACE 2004 study. Twelve percent of patients had a history of illegal drug abuse, 59% had paranoid schizophrenia, 11% had residual schizophrenia, and 6% showed undifferentiated schizophrenia, with a significant skewing to a greater proportion (71% vs. 47%) of the paranoid subtype among “de novo” patients. On inclusion, 9% were suffering an acute exacerbation, 72% showed a stable disorder, and 18% had active symptoms. Up to 96% of patients included “de novo” had been previously treated with antipsychotic drugs, mainly risperidone (27%), and olanzapine (17%). After inclusion in the study, the antipsychotic drugs most frequentely prescribed were aripiprazole (25%), risperidone (18%), olanzapine (10%), and amisulpiride (8%). Training for psychosocial functioning, and occupational therapy (about 15% each) were the most frequent non-pharmacologic interventions (44% of all patients) used before entering in the study.Conclusions:Patients observed were predominantly unmarried young males with paranoid schizophrenia. The proportion of patients with this subtype was greater than that recorded for patients who previously participated in ACE 2004 study. A trend towards treatment with aripiprazole or risperidone was observed.