A One-year Follow-up Study Of Psychosocial And Economic Outcome In Patients With Stabilized Schizophrenia

Part one: psychosocial outcomeObjectiveThe aim of this study was to evaluate the effect of comprehensive intervention and regular pharmacotherapy on psychosocial outcome in patients with stabilized schizophrenia.MethodsUnder natural and realistic environment, a multi-center, open, randomized, control study was conducted. 1216 patients with stabilized schizophrenia whose illness course was less than five years were administered with either comprehensive intervention (antipsychotics combined with comprehensive psychosocial intervention) or regular intervention (antipsychotics and regular mental health service) and followed up for one year and the effects on psychosocial outcome were evaluated. The main measurement on psychosocial outcome were quality of life,social functioning,insight and treatment attitude etc.Results1. The SF-36's PF, VT, HT, RP, GH, RE, MH and HT factor scoring in the comprehensive psychosocial intervention group were significantly improved than those of the regular intervention group. And there was significant difference in terms of SDSS,ADL,ITAQ scoring between the two groups (P<0.05) .2. The new employment rate and unemployment rate were 30% and 3.4% respectively in comprehensive intervention group, while 20% and 7.3% respectively in regular intervention group, there was significant difference between the two groups (P<0.05) .3. In the regular intervention group, patients living in non-rural area did better in SDSS and SF-36's HT, RE, SF, VT, GH, BP, RP and PF scoring than those living in rural area. While in the comprehensive psychosocial intervention group, no significant difference was observed in terms of SDSS, ADL, ITAQ and SF—36 factor scoring between patients living in non-rural and rural area.4. Both atypical antipsychotics and typical antipsychotics can improve SF-36 factor scoring as well as the ITAQ, ADL and SDSS scoring. But there was no significant difference between the two groups (P>0.05).5. In both the comprehensive psychosocial intervention and regular intervention group, the SF-36's HT, RE, SF, VT, GH, BP, RP, PF and MH scoring in female patients was comparable than those of the male patients (P>0.05) .6. In terms of SDSS, ADL, ITAQ and SF-36 factor scoring, no significant difference was observed between patients with high education level and low education level. (P>0.05)Conclusion1. As compared with regular pharmacotherapy, comprehensive intervention can better improve the psychosocial outcome in patients with stabilized schizophrenia.2. In the regular intervention group, the psychosocial outcome was better for patients living in non-rural area than those living in rural area. While in the comprehensive intervention group, no significant difference was observed.3. Both typical and atypical antipsychotics can improve the psychosocial outcome in patients with schizophrenia. But no significant difference was observed between the two groups.4. No gender difference in quality of life was observed.5. Education did not affect psychosocial outcome in patients with schizophrenia. Part two economic outcome: disease burden and cost-effectiveness analysis and comprehensive evaluation of antipsychotics.ObjectiveThe purpose of this study was to explore the impact on economic outcome of different intervention in patients with stabilized schizophrenia and conduct comprehensive evaluation on 7 antipsychotics.MethodsUnder natural and realistic environment, a multi-center, open, randomized, control study was conducted. 1216 patients with stabilized schizophrenia whose illness course was less than five years were administered with either comprehensive intervention (antipsychotics combined with comprehensive psychosocial intervention) or regular treatment (antipsychotics and general mental health service) and followed up for one year. The effect on family burden of disease of different intervention model was evaluated. Cost-effectiveness and cost-utility analysis were conducted to compare different intervention and different type of antipsychotics. Meanwhile comprehensive evaluation (TOPSIS method) was conducted on 7 commonly used antipsychotics in daily clinical practice.Results1.At the time point of 12 month, the FBS scores in the regular pharmacotherapy group were 6.8±6.0, and 6.0±4.9 for the comprehensive intervention group. There was significant difference between the two groups. (P=0.033)2. The 12 months total cost in the regular pharmacotherapy group was 10705.2±826.3 RMB, the median effectiveness was 8.3513, the 12 months total cost in the comprehensive intervention group was 12985.5±1227.4 RMB, the median effectiveness was 8.5725. For one effectiveness, the comprehensive intervention group should cost 1052.8 RMB more than the regular pharmacotherapy group.3. The 12 months total cost in the regular pharmacotherapy group was 10705.2±826.3 RMB, the QALYs achieved was 0.0552; the 12 months total cost in the comprehensive intervention group was 12985.5±1227.4 RMB, the QALYs acquired was 0.0993. It costs 193934.8 RMB to achieve 1 QALYs for the regular pharmacotherapy group, and it costs 130770.2 RMB to achieve 1 QALYs for the comprehensive intervention group.4. The 12 months total cost in the typical antipsychotic group was 7235.8 RMB, the median effectiveness achieved was 8.6967, C/E value was 832.0; The 12 months total cost in the atypical antipsychotic group was 13892.0 RMB, the median effectiveness achieved was 8.9935, C/E value was 1544.7.5. The 12 months total cost in the typical antipsychotic group was 7235.8 RMB, the QALYs achieved was 0.073; The 12 months total cost in the atypical antipsychotic group was 13892.0 RMB, the QALYs achieved was 0.081. It costs 99120.5 RMB for the typical antipsychotic group to achieved 1 QALY and It costs 171506.8 RMB for the atypical antipsychotic group to achieved 1 QALY.6. The sequential order of total cost among seven antipsychotics was clozapine, sulpiride, chlorpromazine, aripiprazole, Risperdal, Seroquel and lastly Zyprexa. The performance of aripiprazole and clozapine was the same in PANSS score-reducing followed by sulpiride, chlorpromazine and Risperdal, Zyprexa, Seroquel. Risperdal ranked first in QALYs gaining followed by Zyprexa, Seroquel, aripiprazole, clozapine, sulpiride and chlorpromazine.7. Clozapine ranks first in Ci value followed by sulpiride, chlorpromazine, aripiprazole, Risperdal, Seroquel and Zyprexa.Conclusion1.Comprehensive intervention could be better in reducing the family burden of sickness in patients with stabilized schizophrenia.2.Comprehensive intervention is superior to regular pharmacotherapy in cost-utility, but regular pharmacotherapy is superior to comprehensive intervention in cost- effectiveness.3.Typical antipsychotics are superior in both cost- utility and cost-effectiveness to those of atypical antipsychotics. 4. TOPSIS showed clozapine was the best.