Product information and disease description Place of product in therapy Disease description Burden of Schizophrenia

Humanistic burden and health-related quality of life

18 evidence topics · 18 sources

Health state utilities for stable schizophrenia, relapse, and antipsychotic adverse events: time trade-off in patients and laypersons

“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.” (opens the source at this quote in a new tab)
“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.” (opens the source at this quote in a new tab)
“Of the treatment-related adverse events, EPS had the lowest mean utility (0.57 and 0.72, respectively).” (opens the source at this quote in a new tab)
“On average, patient utilities are 0.077 points higher than utilities derived from laypersons, although the ranking was similar between the two groups.” (opens the source at this quote in a new tab)

Health state	Patient sample, mean utility (standard error)	Lay sample, mean utility (standard error)
Stable schizophrenia	“0.919 (0.023)”	“0.865 (0.021)”
Weight gain	“0.825 (0.028)”	“0.779 (0.024)”
Hyperprolactinemia	“0.815 (0.030)”	“0.783 (0.025)”
Diabetes	“0.769 (0.036)”	“0.712 (0.028)”
Extrapyramidal symptoms	“0.722 (0.037)”	“0.574 (0.032)”
Relapse	“0.604 (0.042)”	“0.479 (0.033)”

Health state utilities by symptom severity and adverse effect: standard gamble in the United States general public

“Subjects: 620 well-educated, ethnically diverse volunteers (54% Caucasian), who spanned a broad range of age groups and geographical regions of the US participated in this study.” (opens the source at this quote in a new tab)
“In the remaining 441 subjects, SG utilities, re-weighted to match US population demographic profiles, ranged from 0.88 for mild schizophrenia to 0.47 extremely severe schizophrenia.” (opens the source at this quote in a new tab)
“Modest reductions in symptoms (for example, from severe to moderate or moderate to mild) were associated with relatively large changes in utility (0.12-0.19).” (opens the source at this quote in a new tab)
“Adverse effects decreased utilities for states by amounts ranging from 0.09 (pseudo-parkinsonism) to 0.05 (obesity).” (opens the source at this quote in a new tab)

Health state utility values by symptom severity and instrument: systematic review and meta-analysis

“A total of 54 studies involving 87 335 participants were included.” (opens the source at this quote in a new tab)
“The pooled estimate using direct elicitation was a mean HSUV of 0.79 (95% CI: 0.70-0.88) for mild symptomatic states, 0.69 (95% CI: 0.54-0.85) in moderate states, and 0.34 (95% CI: 0.13-0.56) in severe states.” (opens the source at this quote in a new tab)
“Studies using indirect techniques resulted in a pooled mean HSUV of 0.73 (95% CI: 0.67-0.78) applying the EuroQol 5-dimension, 0.66 (95% CI: 0.62-0.71) in the Short-Form 6-dimension, and 0.59 (95% CI: 0.57-0.61) using the Quality of Well-Being scale.” (opens the source at this quote in a new tab)

EQ-5D utility decrements for extrapyramidal symptoms, weight gain, sexual dysfunction, and sedation: European Schizophrenia Cohort

“This sample consisted of 1208 patients with schizophrenia.” (opens the source at this quote in a new tab)
“Patients reporting none of the studied side-effects had an average EQ-5D index score of 0.81, found to be higher than scores of patients reporting EPS (0.70), sexual dysfunction (0.67), sedation (0.70), or weight gain (0.72).” (opens the source at this quote in a new tab)
“The random effects model reported a utility decrement of 0.042 for EPS, 0.022 for weight gain, 0.022 for sexual dysfunction, and 0.019 for sedation.” (opens the source at this quote in a new tab)

Disability weights and years lived with disability: Global Burden of Disease Study 2016

“The estimated disability weights for acute and residual states of schizophrenia were 0.778 (0.606–0.900) and 0.588 (0.411–0.754), respectively.” (opens the source at this quote in a new tab)
“Acute schizophrenia carries the highest disability weight of all disorders in GBD.” (opens the source at this quote in a new tab)
“Overall, 62.7% (28.8%–91.4%) of schizophrenia cases fell within an acute state and 37.3% (8.6%–71.2%) fell within a residual state.” (opens the source at this quote in a new tab)
“Schizophrenia contributes 13.4 (95% UI: 9.9–16.7) million YLDs to burden of disease globally, equivalent to 1.7% of total YLDs globally in 2016.” (opens the source at this quote in a new tab)

Share of mental disorder disability-adjusted life-years: Global Burden of Disease Study 2019

“Depressive disorders accounted for the largest proportion of mental disorder DALYs in 2019 (37·3% [32·3–43·0]), followed by anxiety disorders (22·9% [18·6–27·5]) and schizophrenia (12·2% [9·6–15·2]; figure 1 ; appendix p 38 ).” (opens the source at this quote in a new tab)

Functional outcomes: employment at baseline in the CATIE trial

“Baseline data on more than 1,400 patients with a diagnosis of schizophrenia were collected before their entry into the CATIE study.” (opens the source at this quote in a new tab)
“Altogether, 14.5% of the patients reported participating in competitive employment in the month before the baseline assessment, 12.6% reported other (noncompetitive) employment activity, and 72.9% reported no employment activity.” (opens the source at this quote in a new tab)

Psychosocial functioning on the Quality of Life Scale during antipsychotic treatment in the CATIE trial

“Psychosocial functioning was assessed using the Quality of Life Scale.” (opens the source at this quote in a new tab)
“Psychosocial functioning modestly improved for the one-third of phase 1 patients who reached the primary Quality of Life Scale analysis endpoint of 12 months (average effect size 0.19 SD units).” (opens the source at this quote in a new tab)
“There were no significant differences among the treatment groups in the amount of change in the Quality of Life Scale total score or subscale scores at 6, 12, or 18 months.” (opens the source at this quote in a new tab)
“More substantial improvements would likely require more intensive adjunctive psychosocial rehabilitation interventions.” (opens the source at this quote in a new tab)

Functional and social outcomes associated with relapse: United States physician and patient survey

“Of these, 469 patients (mean age, 39.6 years; 56.5% male) had known hospitalisation history for the last 12 months and completed a PSC; 116 (24.7%) patients had ≥1 relapse.” (opens the source at this quote in a new tab)
“Compared to patients without relapses, patients who relapsed were more likely to be homeless, unemployed, previously incarcerated, and currently have difficulties living independently (all p < 0.05).” (opens the source at this quote in a new tab)
“Patients who experience a relapse also had greater working impairment and poorer quality of life compared with those who did not relapse.” (opens the source at this quote in a new tab)

Stigma: prevalence of perceived stigma, experienced stigma, and self-stigma

“Of 54 studies (n=5,871), published from 1994 to 2011, 23 (42.6%) reported on prevalence rates, and 44 (81.5%) reported on correlates and/or consequences of perceived or experienced stigmatization or self-stigma.” (opens the source at this quote in a new tab)
“On average, 64.5% (range: 45.0–80.0%) of patients perceived stigma, 55.9% (range: 22.5–96.0%) actually experienced stigma, and 49.2% (range: 27.9–77.0%) reported alienation (shame) as the most common aspect of self-stigma.” (opens the source at this quote in a new tab)

Patient-reported burden of second-generation antipsychotic side effects: seven-country web survey

“In total, 435 participants (mean age: 38 years, 53.8% female) were included.” (opens the source at this quote in a new tab)
“Key side effects impacted physical, social, occupational and psychological aspects of functioning.” (opens the source at this quote in a new tab)
“Total Q-LES-Q-SF score showed a significant inverse correlation with the score of pre-defined groups of side effects indicating worse QoL in association with more severe key side effects in these patients.” (opens the source at this quote in a new tab)

Side effects, adherence, and resource use: United States nationwide patient survey

“Data were analyzed from a 2007-2008 nationwide survey of adults who self-reported a diagnosis of schizophrenia and were currently using an antipsychotic medication (N = 876).” (opens the source at this quote in a new tab)
“A majority of patients reported experiencing at least one side effect due to their medication (86.19%).” (opens the source at this quote in a new tab)
“When grouped as side effect clusters in a single model, extra pyramidal symptoms (EPS)/agitation (odds ratio (OR) = 0.57, p = 0.0007), sedation/cognition (OR = 0.70, p = 0.033), prolactin/endocrine (OR = 0.69, p = 0.0342), and metabolic side effects (OR = 0.64, p = 0.0079) were all significantly related with lower rates of adherence.” (opens the source at this quote in a new tab)
“Those who reported complete adherence to their medication were significantly less likely to report a hospitalization for a mental health reason (OR = 0.51, p = 0.0006), a hospitalization for a non-mental health reason (OR = 0.43, p = 0.0002), and an emergency room (ER) visit for a mental health reason (OR = 0.60, p = 0.008).” (opens the source at this quote in a new tab)

Tolerability ranking of antipsychotic side effects: patients and caregiver proxies

“A cross-sectional survey was conducted with 200 people living with schizophrenia and 100 caregiver proxies for those with severe disease presentation.” (opens the source at this quote in a new tab)
“Results indicated that extrapyramidal side effects such as pseudoparkinsonism and tardive dyskinesia, as well as feeling detached and memory and cognitive issues were ranked as the least tolerable.” (opens the source at this quote in a new tab)
“Side effects such as pseudoparkinsonism, memory and cognitive problems, and weight gain were associated with unwillingness to initiate or continue an effective antipsychotic medication.” (opens the source at this quote in a new tab)

Patient preferences: anticipated weight gain and willingness to change antipsychotic medication

“When asked about willingness to change antipsychotic medication, anticipated weight gain had a negative influence on willingness to try the new treatment, with 22.0% declining to try a medication that would lead to weight gain of 2.7–4.5 kg (6–10 lb), 34.0% declining for anticipated weight gain of 5.0–9.1 kg (11–20 lb), and 52.4% declining for anticipated weight gain greater than 9 kg (20 lbs).” (opens the source at this quote in a new tab)

Patient preferences: discrete-choice experiment on benefits, risks, and formulation in the United States

“The final sample consisted of 271 patients.” (opens the source at this quote in a new tab)
“Complete improvement in positive symptoms was the most preferred outcome (relative importance score of 10.0), followed by elimination of hyperglycemia (3.6, 95% confidence interval [CI]=2.6-4.6), improvement in negative symptoms (3.0, CI=1.6-4.3), reduced weight gain (2.6, CI=1.2-4.0), avoidance of hyperprolactinemia (1.7, CI=.9-2.6), improved social functioning (1.5, CI=.4-2.5), and avoidance of EPS (1.0, CI=.3-1.8).” (opens the source at this quote in a new tab)
“Patients judged a daily pill superior to monthly injections (p<.01) and monthly injections superior to injections every three months (p<.01) for adherent patients and monthly injections superior to a daily pill for nonadherent patients (p=.01).” (opens the source at this quote in a new tab)

Patient preferences: discrete-choice experiment on attributes of oral antipsychotics

“In total, 144 respondents with SZ and 152 with BD-I completed the DCE.” (opens the source at this quote in a new tab)
“Treatment efficacy was the most important attribute, with a conditional relative importance (CRI) of 31.4% for respondents with SZ and 31.0% for those with BD-I.” (opens the source at this quote in a new tab)
“Weight gain (CRI = 21.3% and 23.1%, respectively) and sexual dysfunction (CRI = 23.4% and 19.2%, respectively) were adverse effects in this study that respondents most wanted to avoid.” (opens the source at this quote in a new tab)
“Respondents with SZ were willing to accept 9.8 lb of weight gain or > 25% risk of sedation for symptom improvement; those with BD-I were willing to accept 8.5 lb of weight gain or a > 25% risk of sedation.” (opens the source at this quote in a new tab)

Sexual dysfunction: pooled prevalence in a systematic review and meta-analysis

“A total of 72 of 1119 studies from 33 countries on 6 continents published from inception to June 2022 were included with a total of 21 076 participants with schizophrenia.” (opens the source at this quote in a new tab)
“The pooled global prevalence of sexual dysfunctions was 56.4% (95% CI, 50.5-62.2), with a prevalence of 55.7% (95% CI, 48.1-63.1) for men and 60.0% (95% CI, 48.0-70.8) for women.” (opens the source at this quote in a new tab)
“The most frequent sexual dysfunction was erectile dysfunction in men (44%; 95% CI, 33.5-55.2), followed by loss of libido in men (41%; 95% CI, 30.7-51.4), ejaculation dysfunction in men (39%; 95% CI, 26.8-51.8), orgasm dysfunction in women (28%; 95% CI, 18.4-40.2), and amenorrhea in women (25%; 95% CI, 17.3-35.0).” (opens the source at this quote in a new tab)

Sexual dysfunction and quality of life in men treated with antipsychotics

“Sexual dysfunction occurred in 45.3% of patients.” (opens the source at this quote in a new tab)
“However, as compared with patients without sexual dysfunction, patients with sexual dysfunction reported significantly lower ratings on global quality of life (t = 2.4, df = 136, p = .02) and the level of enjoyment in their life (t = 2.5, df = 136, p = .01).” (opens the source at this quote in a new tab)
“Patients with sexual dysfunction were significantly less likely than those without sexual dysfunction to report having a romantic partner (17.5% vs. 43.4%; chi(2) = 10.7, df = 1, p = .001), though they were not significantly less likely to report difficulty making friends (27.0% vs. 32.9%; chi(2) = 0.57, df = 1, p = .45).” (opens the source at this quote in a new tab)