Impact of schizophrenia and schizophrenia treatment-related
adverse events on quality of life: direct utility elicitation
Abstract
Objective: To examine the impact of schizophrenia, its treatment and treatment-related adverse events related to antipsychotics, on quality of life from the perspective of schizophrenia patients and laypersons.
Methods: Health state descriptions for stable schizophrenia, extra pyramidal symptoms (EPS), hyperprolactinemia, diabetes, weight gain and relapse were developed based on a review of the literature and expert opinion. The quality of life impact of each health state was elicited using a time trade-off instrument administered by interview to 49 stable schizophrenia patients and 75 laypersons. Regression techniques were employed to examine the importance of subject
characteristics on health-related utility scores.
Results: Patients and laypersons completed the interview in similar times. Stable schizophrenia had the highest mean utility (0.87 and 0.92 for laypersons and patients respectively), while relapse (0.48 and 0.60) had the lowest mean utility. Of the treatment-related adverse events, EPS had the lowest mean utility (0.57 and 0.72, respectively). Age, gender and PANSS score did not influence the utility results independently of health state. On average, patient utilities are 0.077 points higher than utilities derived from laypersons, although the ranking was similar between the two groups.
Conclusion: Events associated with schizophrenia and treatment of schizophrenia can bring about a significant detriment in patient quality of life, with relapse having the largest negative impact.Results indicate that patients with stable schizophrenia are less willing to trade years of life to avoid schizophrenia-related symptoms compared to laypersons. Both sets of respondents showed equal ability to complete the questionnaire.
Conclusion
In conclusion, there were clear differences between patient and layperson responses to the utility questionnaire. However, the preference ordering of these health states was similar, with stable schizophrenia having the lowest impact on quality of life and relapse and EPS the greatest impact on quality of life, indicating as clear an understanding by patients of the health states and their impact on quality of life as by laypersons. In a disease such as schizophrenia, chronic side-effects of treatment such as weight gain and diabetes may have just as large an impact on QALYs as the acute symptoms of the condition itself.