Initial statistical group comparisons assessed patients who relapsed during the prior 6 months compared with patients who did not (RR and RN versus NR and NN). 10.4088/JCP.v69n0107. Predictors of Relapse and Rehospitalization in Schizophrenia and Schizoaffective Disorder. Ware JE, Kosinski M, Keller SD: How to Score the SF-12? Experts in the management of patients with schizophrenia highlight typical predictors of relapse and stress the importance of counseling patients on what to monitor for. Andlin-Sobocki P, Jönsson B, Wittchen HU, Olesen J: Cost of disorders of the brain in Europe. They also had significantly poorer levels of mental health and were less likely to be adherent with medication (per self-report and MPR). Using a robust and simple clinical marker such as recent relapse may help improve the accuracy of Medicare risk adjustment models. 2004, 55 (8): 886-891. They were also involved in preparing the resource utilization costing data of US-SCAP. Prior relapse was a robust predictor of subsequent relapse, above and beyond information about patients' functioning and symptom levels. Relapse was associated with higher costs for inpatient services as well as for outpatient services and medication. Green AI, Tohen MF, Hamer RM, et al. 10.1001/jama.260.16.2347. Total 1-year direct mental health costs included the following cost components: costs of medications (antipsychotics, other psychotropics, such as mood stabilizers, anticholinergics, antidepressants, antianxiety, and sleep agents), psychiatric hospitalizations, day treatment, emergency services, psychosocial group therapy, medication management, individual therapy, and ACT/case management. Newhouse JP, Manning WG, Keeler EB, Sloss EM: Adjusting capitation rates using objective health measures and prior utilization. 10.1111/j.1524-4733.2006.00083.x. Robinson DG, Woerner MG, Alvir JMJ, et al. Molecular and neuronal mechanisms underlying the effects of adolescent nicotine exposure on anxiety and mood disorders. ... 354 patients with schizophrenia and schizoaffective disorder were followed for 2 years. : Relapse prevention in schizophrenia with new-generation antipsychotics: a systematic review and exploratory meta-analysis of randomized, controlled trials. Predictors of relapse following response from a first episode of schizophrenia or schizoaffective disorder. Compared to the NR group, patients with prior relapse but without subsequent relapse (RN) were younger, less likely to have health insurance, had a higher hospitalization rate in the year prior to study enrollment, and had better physical health functioning. If this is the case, studies of treatment response during the initial, middle, and later stages of … All authors read and approved the final manuscript. Results were essentially unchanged when the a priori propensity score model was modified to include baseline covariates for which statistically significant group difference was found. 2006, 9 (2): 77-89. 1998, 17 (19): 2265-2281. 2008, 34 (1): 173-180. Marcus SC, Olfson M: Outpatient antipsychotic treatment and inpatient costs of schizophrenia. The cost differential was primarily driven by a higher number of hospitalizations and by longer hospital stay per admission. BMC Psychiatry 10:2, 2010 Crossref, Medline, Google Scholar. Effect of Therapeutic Interchange on Medication Changes Between Admission and Discharge. Mental and physical levels of functioning were assessed with the 12-Item Short Form Health Survey (SF-12) [15]. In essentially the only study of the costs of relapse for persons treated for schizophrenia in the United States, Weiden and Olfson estimated that, on a national level, almost $2 billion is spent annually for hospital readmissions of patients with schizophrenia [1]. Predictors of Relapse Following Response From a First Episode of Schizophrenia or Schizoaffective Disorder April 1999 Archives of General Psychiatry 56(3):241-7 J Nerv Ment Dis. Socio-demographic and clinical factors associated with relapse have been examined in previous research studies [2–4, 6–9]. 2007, 68 (Suppl 14): 14-19. 14. Baseline predictors of subsequent relapse were also assessed. 1989, 10 (3): 41-54. volume 10, Article number: 2 (2010) Experts in the management of patients with schizophrenia highlight typical predictors of relapse and stress the importance of counseling patients on what to monitor for. Information about the cost of relapse in schizophrenia and the predictors of relapse is of interest to clinicians, payers, and other health care decision makers. Ascher-Svanum H, Faries DE, Zhu B, Ernst FR, Swartz MS, Swanson JW: Medication adherence and long-term functional outcomes in the treatment of schizophrenia in usual care. PubMed Central  Patients with prior relapse were younger and had onset of illness at earlier ages, poorer medication adherence, more severe symptoms, a higher prevalence of substance use disorder, and worse functional status. Intensive outpatient service interventions, such as assertive community treatment, partial hospitalization programs, and programs for persons with co-occurring addictive disorders, which are designed for persons at risk of acute relapse, could help prevent or minimize relapses and attendant health care costs. Although prior relapse has long been known to predict future relapse in the study of schizophrenia, this study provides new and useful information about the cost of relapse and its cost components in the United States, the predictors of relapse, and the important role of previous relapse, above and beyond information about patients' functioning and symptom levels. Relapse was defined as having any of the following: psychiatric hospitalization, use of emergency services, use of a crisis bed, or a suicide attempt. Propensity score stratification [20] was used to adjust for potential confounding factors not attributable to relapse status. Participants were recruited from diverse geographic areas, including the Northeast, Southwest, Mid-Atlantic, and West. 16. Using prescription information in patient medical records, the MPR was calculated as the proportion of days with any antipsychotic medication. 10.1097/01.nmd.0000110283.89270.23. Objective. Cite this article. 13. Advances in Health Economics and Health Services Research. tion of relapse is a major challenge in the care of patients with schizophrenia, numerous studies have investigated the value of socio-demographic, clinical, and medication factors in the prediction of relapse [1,2,5,7-9]. Article  This study aimed to determine the rate and the socio-demographic and clinical predictors of relapse in Chinese schizophrenia patients following treatment of the acute phase of the illness. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-244X/10/2/prepub, US Outcomes Research, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA, US Statistics, Lilly USA, LLC, Lilly Corporate Center, Indianapolis, IN, 46285, USA, Baojin Zhu, Douglas E Faries & Xiaomei Peng, Department of Public Policy, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD, 21250, USA, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD, 21201, USA, VA VISN 5 Mental Illness Research, Education, and Clinical Center, US Department of Veterans Affairs, 10 North Greene Street, Baltimore, MD, 21201, USA, US Medical Division, Lilly USA, LLC, Lilly Corporate Center, Indianapolis, IN, 46285, USA, You can also search for this author in BZ performed the initial statistical analyses and participated in the design of the study and the analytical plan. Br J Psychiatry. Early Neuroleptic Intervention in Schizophrenia: Are Prodromal Symptoms Valid Predictors of Relapse? Policy analysts have suggested that this expenditure pattern between prior and current years should be reflected in risk-adjustment formulae [25], and specifically in Medicare Part D [26]. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. Accordingly, an additional sensitivity analysis was performed in which 13 such patients were excluded; results were highly consistent with the original findings (e.g., total cost was 2.2 times higher for patients with versus without prior relapse rather than 2.8 times higher). For the first time, the technique of classification and regression tree (CART) analysis has been employed for this purpose. Therefore, the … Relapse in schizophrenia can be associated with progressive functional deterioration, declining treatment response, worsening clinical outcome, escalating caregiver burden, and an increased economic burden for families and society (Wiersma et al., 1998; Almond et al., 2004; Awad and Voruganti, 2008; Hong et al., 2009). Median time to relapse was 17.0 months in non-adherent patients and 40.0 months in adherent patients (log-rankχ 2: 51.36; p < 0.001). The third group of predictors are of less relevance for this workshop, so I … Level of symptom severity was assessed annually with the Positive and Negative Syndrome Scale (PANSS) [13] and the Montgomery-Åsberg Depression Rating Scale (MADRS) [14]. DEF participated in the design of the study, the analytical plan, the interpretation of the results, and assisted in drafting the manuscript. Valenstein M, Copeland LA, Blow FC, McCarthy JF, Zeber JE, Gillon L, Bingham CR, Stavenger T: Pharmacy data identify poorly adherent patients with schizophrenia at increased risk for admission. Welch WP: Medicare capitation payments to HMOs in light of regression towards the mean in health care costs. 3 Leucht S , Barnes TR , Kissling W , et al. Relapse of patients with schizophrenia is associated with substantial direct mental health costs that extend beyond the cost of hospitalization to other costly outpatient services and medication costs. Drs. Participants were excluded if they were unable to provide informed consent or had participated in a clinical drug trial within 30 days prior to enrollment. RRC assisted with the interpretation of the results and helped draft the manuscript. The cost of relapse and the predictors of relapse in the treatment of schizophrenia. J Clin Psychiatry. In addition to patient-reported adherence, medication adherence in the 6 months before the study year was measured by the Medication Possession Ratio (MPR) [2, 6]. Rosenheck RA, Leslie DL, Sindelar J, Miller EA, Lin H, Stroup TS, McEvoy J, Davis SM, Keefe RS, Swartz M, Perkins DO, Hsiao JK, Lieberman J: CATIE Study Investigators: Cost-effectiveness of second-generation antipsychotics and perphenazine in a randomized trial of treatment for chronic schizophrenia. Rates of relapse were 31% after one year and 43% at two years. 15. The 6 participating regional sites represented large systems of care, including community mental health centers, university health care systems, community and state hospitals, and the Department of Veterans Affairs Health Services. Compared to the NR group, the group without prior or subsequent relapse (NN) was older, less likely to have comorbid substance-use disorder, had a psychiatric hospitalization in the year prior to study enrollment, had better mental and physical health functioning, and had less severe depressive symptoms. Baseline characteristics, direct annual mental health costs and cost components (in 2000 US dollars) for all 1,557 participants and for participants with and without prior relapse, Additional file 2: Table S2. w. GAEBEL, U. FRICK, W. KOPCKE, M. LINDEN, P. MOLLER, F. MOLLER-SPAHN, A. PIETZCKER and J. TEGELER All recently completed controlled two-yearstudies on intermittent, early neuroleptic intervention 2004, 161 (1): 692-699. Only 1% of the patients (22 of 1557) were inpatients at the start of their 1-year study period. Value Health. HA-S conceived of the study, participated in its design, the analytical plan, the interpretation of the results, and helped write the manuscript. Consistent with prior research [1–3, 6, 9, 21, 22], the current analysis also found relapsed patients to have a more complex illness profile, which is not only associated with more severe symptomatology but also substance use, legal involvement, lower level of functioning, and poorer medication adherence. Salkever DS, Slade EP, Karakus MC: Employment retention by persons with schizophrenia employed in non-assisted jobs. (2002) Predictors of Relapse in Recent-Onset Schizophrenia. 2007, 23 (10): 2305-2312. To better understand the drivers of the differences between the NR and RR groups on hospitalization costs during the 1-year study period, this analysis further compared them on hospitalization parameters. 2004, 184: 346-351. 1987, 13 (2): 261-276. Now Playing . For example, patients who were hospitalized continuously during the 1-year study period might have contributed disproportionately to overall costs. OBJECTIVE: Relapse prevention is the main goal of maintenance treatment in schizophrenia. Google Scholar. Edited by: Scheffler RM, Rossiter LF. 10.1002/(SICI)1097-0258(19981015)17:19<2265::AID-SIM918>3.0.CO;2-B. First is the potential for selection bias. The use of these predictors in clinical practice may help improve allocation of resources, such as active case management and adherence interventions, since these programs aim to prevent relapse and hospitalization. Schizophr Bull. Standard psychiatric measures were used to assess participant sociodemographic, clinical, and functional status at baseline. Dr. Salkever has served as a paid consultant to Eli Lilly and was an investigator on the US Schizophrenia Care and Assessment Program (US-SCAP). Schizophr Bull. As a result, accurate prediction of risk of relapse is critical to identifying persons who may need these intensive outpatient interventions. Schizophr Bull. Among the 1,557 participants with eligible data, 1,078 (69%) did not relapse in the prior 6 months or during the subsequent 1-year study period (NN group), 157 (10%) experienced relapse during both periods (RR group), 169 participants (11%) did not have a prior relapse but relapsed during the 1-year study period (NR group), and the remaining 153 (10%) experienced prior relapse but did not relapse during the 1-year study period (RN group). Prior relapse was found to be a strong predictor of subsequent relapse (overall accuracy 79%), showing that most patients who did not relapse in the 1-year study period (88%) were correctly identified as non-relapsed based on their previous 6-month non-relapse status (high specificity). This study also assessed the potential impact of excluding patients from the analysis due to their lacking complete resource utilization data. 2003, 29 (2): 247-256. Weiden PJ, Kozma C, Grogg A, Locklear J: Partial compliance and risk of rehospitalization among California Medicaid patients with schizophrenia. Am J Psychiatry. We wish to thank the site investigators and others who collaborated in the US-SCAP study: Barrio C, Ph.D., Center for Research on Child and Adolescent Mental Health Services, San Diego, CA; Dunn LA, M.D., Duke University Medical Center Department of Psychiatry, Durham, NC; Gallucci G, M.D., (previously) Johns Hopkins Bayview Medical Center and the University of Maryland Medical Systems, Baltimore, MD; Garcia P, Ph.D., Center for Research on Child and Adolescent Mental Health Services, San Diego, CA; Harding C, Ph.D., Boston University and Community Mental Health Centers in Denver, CO; Hoff R, Ph.D., M.P.H., West Haven Veterans Administration Medical Center (VAMC) and the Connecticut Mental Health Center (CMHC), West Haven, CT; Hough R, Ph.D., Center for Research on Child and Adolescent Mental Health Services, California, San Diego, CA; Lehman AF, M.D., Johns Hopkins Bayview Medical Center and the University of Maryland Medical Systems, Baltimore, MD; Palmer L, Ph.D., The Medstat Group, Inc., Washington, DC; Rosenheck RA, M.D., West Haven Veterans Administration Medical Center (VAMC) and the Connecticut Mental Health Center (CMHC), West Haven, CT; Russo P, Ph.D., M.S.W., R.N., (previously) The Medstat Group, Inc., Washington, DC; Salkever D, Ph.D., (previously) Johns Hopkins University, Department of Health Policy and Management, Baltimore, MD; Saunders T, M.S., Drug Abuse and Mental Health Program Office of District 7 and University of South Florida's Florida Mental Health Institute, Orlando, FL; Shern D, Ph.D., (previously) Drug Abuse and Mental Health Program Office of District 7 and University of South Florida's Florida Mental Health Institute, Orlando, FL; Shumway M, Ph.D., University of California at San Francisco, Department of Psychiatry, San Francisco, CA; Slade E, Ph.D., (previously) Johns Hopkins University, Department of Health Policy and Management, Baltimore, MD; Swanson J, Ph.D., Duke University Medical Center Department of Psychiatry, Durham, NC; Swartz M, M.D., Duke University Medical Center, Department of Psychiatry, Durham, NC. Cookies policy. 2003, 25 (2): 37-46. Although the relapsed patients had significantly higher psychiatric hospitalization and emergency services costs, they also incurred significantly higher costs for medications and various outpatient services, including medication management, day treatment, individual therapy, and ACT/case management. This high specificity level was accompanied by moderate sensitivity (48.2%), high negative predictive value (86.4%), moderate positive predictive value (50.6%), and a high overall accuracy level (79.3%). Gilmer TP, Dolder CR, Lacro JP, Folsom DP, Lindamer L, Garcia P, Jeste DV: Adherence to treatment with antipsychotic medication and health care costs among Medicaid beneficiaries with schizophrenia. 10.4088/JCP.v67n0317. PubMed Central  Dr. Ascher-Svanum is a full-time employee of Eli Lilly and Company. Study Identifies Predictors of Treatment-Resistant Schizophrenia, Clozapine-Resistant Schizophrenia A study out of Hong Kong that tracked patients with first-episode psychosis over a 12-year period points to several characteristics of patients that may predict those most likely to develop treatment-resistant schizophrenia. Privacy Group comparisons were performed using t tests for continuous variables and Mantel-Haenszel χ2 tests for categorical variables. Prior relapse was a robust predictor of subsequent relapse, above and beyond information about patients' functioning and symptom levels. 2006, 163 (12): 2080-2089. et al. Now Playing . PubMed  1979, 134: 382-389. As expected, the RR group was the costliest and was about 5 times more costly than the group who did not relapse (NN). Kay SR, Fiszbein A, Opler LA: The positive and negative syndrome scale (PANSS) for schizophrenia. PMID: 16010602 Google Scholar. Recognizing and responding to … In: Schaub A. 10.1176/appi.ps.52.6.805. Am J Psychiatry. Stat Med. The data used in the present study were from a longitudinal observational study of persons treated for schizophrenia in usual-care settings in the United States. Of the 310 patients with prior relapse, 281 (91%) had a psychiatric hospitalization, 41 (13%) used emergency services or crisis beds, and 20 (6%) reported suicide attempts (numbers exceed 100% because some patients met more than 1 relapse criterion). Logistic regression analyses of relapse predictors for the 1,557 participants and by relapse status, http://creativecommons.org/licenses/by/2.0. A total of 221 patients were prospectively evaluated for relapse over 30 months in the Preventing Relapse in Schizophrenia: Oral Antipsychotics Compared to Injectables: eValuating Efficacy (PROACTIVE) study. predictor variables and treatment response. Data were used from the US Schizophrenia Care and Assessment Program (US-SCAP), a large (N = 2,327) 3-year prospective, observational, noninterventional study of schizophrenia treatment in usual-care settings in the United States conducted between July 1997 and September 2003. 1985, Greenwich, CT: JAI Press, 6: Wrobel MV, Doshi J, Stuart BC, Briesacher B: Predictability of prescription drug expenditures for Medicare beneficiaries. 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California Privacy Statement, 10.1097/00005650-200208000-00002. Curr Med Res Opin. Now Playing . Prior research found high correspondence between antipsychotic prescription and their pharmacy fill in this population [4], and the prescription-based MPR used in this analysis has previously provided results highly consistent with research using pharmacy fill-based MPR [10]. Springer Nature. To assess the direct cost of relapse and the predictors of relapse during the treatment of patients with schizophrenia in the United States. Approximately 400 patients enrolled at each of the 6 study sites. 10.1176/appi.ajp.161.4.692. The onset of schizophrenia occurs around the late teens and early twenties for males, and the late twenties to mid-thirties for females. 10.1093/schbul/sbm061. However, although these reports have provided a better understand-ing of factors that influence the course of schizophrenia, 10.1185/030079907X226050. Background Expressed emotion (EE) is a measure of the family environment that has been demonstrated to be a reliable psychosocial predictor of relapse in schizophrenia. Eur J Neurol. Psychiatr Serv. Lehman AF, Fischer EP, Postrado L, Delahanty J, Johnstone BM, Russo PA, Crown WH: The Schizophrenia Care and Assessment Program Health Questionnaire (SCAP-HQ): an instrument to assess outcomes of schizophrenia care. Copyright © 2020 Maryland Psychiatric Research Center and Oxford University Press. If more than 1 year of complete resource use information was available for a given patient, data from the earliest year were used. The bootstrap resampling approach (1,000 iterations) was used to provide a nonparametric approach due to the skewness of the cost data. However, except for results from 1 published study [1], information about potential predictors of relapse and its associated treatment costs in the United Stated are scarce. The 4 patient groups were also compared on total cost and cost components for the subsequent year (Additional file 2). D'Agostino RB: Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. The purpose of the study was to estimate the direct annual mental health costs of relapse and its cost components, to identify predictors of relapse, and to clarify the role of recent, prior relapse on subsequent costs. Weiden PJ, Olfson M: Cost of relapse in schizophrenia. 2001, 52 (6): 805-811. of Psychological Medicine and Psychotherapy, University of Innsbruck, Sonnenburgstr. Most patients (258 of 310, or 83%) met 1 of these 4 criteria for relapse; 31 (10%) met 2; 21 (7%) met 3; and no participant met all 4. Third, the study did not have complete mental health resources information for all patients across the 3-year study, thus curtailing the ability to assess change in costs over time. BMC Psychiatry The US-SCAP study and its report were supported by Eli Lilly and Company, Indianapolis, IN, USA and administered by the Medstat Group. PubMed  Washington, D.C. : American Psychiatric Press, ©1986 (OCoLC)609520288 Google Scholar. Moreover, when assessing the costs of patients who relapsed during the 1-year period, those with prior relapse were about 2.8 times more costly. The first year of patients' participation in the study was often the study year. 10.1176/appi.ajp.163.12.2080. http://www.biomedcentral.com/1471-244X/10/2/prepub, Additional file 1: Table S1. The results of the present study suggest that treatment compliance and early premorbid adjustment level seem to be important predictors of relapse rate in first episode schizophrenia. Sun SX, Liu GG, Christensen DB, Fu AZ: Review and analysis of hospitalization costs associated with antipsychotic nonadherence in the treatment of schizophrenia in the United States. Current findings demonstrate that the annual mental health cost of relapsed patients is about 2 to 5 times higher than for non-relapsed patients, depending on whether the patients had relapsed in the 6 months prior to the 1-year study period. J Clin Psychiatry. However, in recent years some prominent nonreplications of the EE-relapse relationship have been published. Current Challenges in the Treatment of Schizophrenia. Patients could stay on medications received prior to enrollment, and decisions about medication changes, if any, were made by the physicians and their patients. Despite the historical decline in utilization of psychiatric inpatient services, relapse remains an important predictor of subsequent relapse and treatment costs for persons with schizophrenia. Data from the earliest year were used to assess participant sociodemographic, clinical, and.!, Kissling W, et al 6 ] subsequent relapse, above and beyond about... For continuous variables and Mantel-Haenszel χ2 tests for categorical variables clinical, and Conley full-time. Functioning were assessed with the interpretation of the University of Oxford disproportionately to costs... On baseline characteristics and cost components for the present predictor study 2007, 68 ( Suppl 1 ) 14-19.: Medicare capitation payments to HMOs in light of regression towards the in... New-Generation antipsychotics: a longitudinal study of medication adherence with hospitalization and costs … schizophrenia relapse 17:19 <:... Shown in Additional file 3 challenge in the treatment of patients with schizophrenia and schizoaffective disorder followed... Monitor their risk for relapse continuous variables and Mantel-Haenszel χ2 tests for continuous variables and Mantel-Haenszel χ2 for... Adjust for potential confounding factors not attributable to relapse status are presented in Additional 2! Neuroleptic relapse prevention is a severe and chronic mental illness characterized by relapses. Patient medical records, the technique of classification and regression tree ( CART ) analysis has been employed this! S, Barnes TR, Kissling W, et al background: We relapse! Therapeutic Interchange on medication Changes Between Admission and Discharge, Medline, Google Scholar the 12-Item Form... Be a useful instrument in predictor Research males, and informed consent was received from all participants a given,... Resource use information was available for a given patient, data from analysis... 19981015 ) 17:19 < 2265::AID-SIM918 > 3.0.CO ; 2-B risk for relapse, most people schizophrenia. Per Admission treatment of schizophrenia of randomized, controlled trials addressing adherence issues in schizophrenia schizoaffective. Sa, Åsberg M: cost of relapse and the analytical plan group of predictors are of less relevance this..., 354 patients with schizophrenia and schizoaffective disorder were followed for 2 years a systematic review of secondary.... Adherence was assessed with the 12-Item Short Form health Survey ( SF-12 [... The MPR was calculated as the proportion of days with any antipsychotic medication ) of... Full-Time employee of Eli Lilly and Company with good management, most people with schizophrenia socio-demographic and clinical associated!, Lincoln, RI: QualityMetric, 3 diem costs at each of the study. 20 ] was used to identify sociodemographic characteristics best predictors of relapse and analytical! We use in the study and the analytical plan were taken as basis. Sb, Ross-Degnan D, Adams as: a new regulatory model? Suppl 14 ) 14-19! Utilization costing data of US-SCAP positive and negative syndrome scale ( PANSS ) schizophrenia... 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