- Email: [email protected]
ECONOMIC IMPACT OF EARLY INTERVENTION IN PEOPLE AT HIGH RISK OF PSYCHOSIS
Abstracts
291
Poster 255
Poster 256
RESOURCE UTILIZATION COSTS IN PSYCHOTIC PATIENTS: THE CANADIAN OSCAR STUDY
ECONOMIC IMPACT OF EARLY INTERVENTION IN PEOPLE AT HIGH RISK OF PSYCHOSIS
L. Kopala1, G. Smith1, R. Williams1, G.W. MacEwan1, A. McIntyre1, I. Kowalchuck1, N. Schnurr1, R. Balshaw2, N. Lesnikova2, WG Honer1 1 University of British Columbia Vancouver, BC, Canada; 2Syreon Corp Vancouver, BC, Canada
Background: This analysis will attempt to identify the predictors of resource-utilization costs in patients with psychosis. Methods: The OSCAR study is a prospective, 12 month, openlabel, naturalistic study of resource-utilization costs in psychotic patients. A total of 138 subjects with schizophrenia or a related psychotic disorder were enrolled from 5 Canadian centers. This analysis examines the baseline data and explores the univariate and multivariate associations between costs and several clinical and socio-demographic covariates. These covariates include age, gender ethnicity (Caucasian vs. other), education (up to grade 12 vs. beyond grade 12), marital status (single vs. other), family history of schizophrenia (yes/no), ratings of symptoms and functioning (SOFAS: Social and Occupational Functioning Scale, PANSS: Positive and Negative Syndrome , SDS: Sheehan Disability Scale, CGI: Clinical Global Impressions Scale), and history of street-drug, alcohol, marijuana, and cigarette use (each yes/no). The distribution of costs was skewed and was log-transformed for analyses. Data were explored using multivariate regression analysis of covariates. The value of resources consumed was expressed in 2007 Canadian dollars, and is based on non-generic drug costs. Results: Of the 138 subjects enrolled, n = 130 provided complete baseline data. Mean age was 40 years (SD = 13.2, 74% male; 88% Caucasian; 12% married or living common-law). One-fifth (21%) had a known family history of schizophrenia and 65% met criteria for a diagnosis of schizophrenia, 24% for schizoaffective disorder and 11% for other psychosis. Medication at baseline was quetiapine for 34, risperidone for 38 and olanzapine for 48 patients. Mean PANSS and SOFAS scores were 63±18.6 and 59 ± 13.7 respectively and 33% were at least moderately ill according to the CGI. Mean SDS scores were Work/School: 4.8 ± 3.64, Social Life: 5.2±3.29, and Family/Home 4.3 ±3.13.Tobacco, marijuana and street-drug use in the past month was 43%, 12%, and 2% and lifetime use in 69%, 62%, and 35%. Alcohol use in the past month was acknowledged by 42% and 95% reported some lifetime use. The mean baseline costs for resources was $1010 ± 1287 per month (32% for hospitalization and out-patient services, 14% for indirect expenses, 41% for medications, and 13% for other community services). The total costs were highly variable and ranged from $55 to $9653 per month. Increased costs were associated with a lower SOFAS scores, and higher PANSS and SDS scores, as well as with tobacco and street-drug use and finally, with type of medication (each p < 0.05). In the multivariate analysis, type of medication and SOFAS scores remained significant (p < 0.05). Discussion: The current analysis indicates that total resource utilization costs are extremely variable and positively associated with more severe symptoms, lower functioning, substance use, and vary by type of medication used.
doi:10.1016/j.schres.2010.02.483
Lucia Valmaggia1,2,3, Paul McCrone1, Martin Knapp1,4, Matthew Broome5, Paddy Power6, Philip McGuire1,2 1 Institute of Psychiatry, KCL London, London, United Kingdom; 2OASIS, South London and Maudsley Trust London, London, United Kingdom; 3 Maastricht University Maastricht, Maastricht, Netherlands; 4London School of Economics London, London, United Kingdom; 5Warwick University Coventry, Coventry, United Kingdom; 6LEO, South London and Maudsley Trust London, London, United Kingdom Background: Despite the increasing development of early intervention services for psychosis, little is known about their costeffectiveness. Aim: We assessed the cost-effectiveness of Outreach And Support In South London (OASIS), a service for people with an at risk mental state for psychosis. Methods: The costs of OASIS compared to Care As Usual were entered in a decision model and examined for 12- and 24-month periods, using the duration of untreated psychosis and rate of transition to psychosis as key parameters. The costs were calculated on the basis of services used following referral and the impact on employment. Sensitivity analysis was used to test the robustness of all the assumptions made in the model. Results: Over the initial 12 months from presentation the costs of the OASIS intervention were £1872 higher than for Care As Usual. However after 24 months they were £961 less than Care As Usual. Conclusions: This model suggests that services that permit early detection of people at high risk of psychosis may be cost saving. doi:10.1016/j.schres.2010.02.484
Poster 257 THE RELATIONSHIP BETWEEN SOCIAL PROBLEM-SOLVING AND EMOTIONAL REGULATION IN PEOPLE WITH SCHIZOPHRENIA Marianne Ayre1,2, Carmel Loughland2,3,4, Miles Bore1, Amanda Baker2,3 1 HunterNew England Health Newcastle, NSW, Australia; 2Univeristy of Newcastle Newcastle, NSW, Australia; 3Centre fro Brain and Mental Health Research Newcastle, NSW, Australia; 4Schizophrenia Research Institute Sydney, NSW, Australia Background: Deficits in social problem-solving skills have been reported in schizophrenia and are known to impact on vocational performance and interpersonal functioning (Revheim et al., 2006). However, few studies have examined the impact of emotional regulation in people with schizophrenia on social problem-solving ability. Methods: The sample consisted of 114 adults (males, n = 57) with a confirmed diagnose of schizophrenia recruited through the resources of the Australian Schizophrenia Research Bank (ASRB), and a 'healthy' control sample of 146 adult (males n = 22) recruited through registered clubs and education classes, and screened for a history of psychiatric disorders. Participants were administered three questionnaires: The Difficulties in Emotion Regulation Scale (DERS), Social Problem Solving Inventory –Revised (SPSI-R), and the Kessler 10 (K10). Results: Independent t-test showed a significant difference in performance between control and schizophrenia samples on the DERS (t(208.70) = -8.19, p = .00), with the schizophrenia sample
291
Poster 255
Poster 256
RESOURCE UTILIZATION COSTS IN PSYCHOTIC PATIENTS: THE CANADIAN OSCAR STUDY
ECONOMIC IMPACT OF EARLY INTERVENTION IN PEOPLE AT HIGH RISK OF PSYCHOSIS
L. Kopala1, G. Smith1, R. Williams1, G.W. MacEwan1, A. McIntyre1, I. Kowalchuck1, N. Schnurr1, R. Balshaw2, N. Lesnikova2, WG Honer1 1 University of British Columbia Vancouver, BC, Canada; 2Syreon Corp Vancouver, BC, Canada
Background: This analysis will attempt to identify the predictors of resource-utilization costs in patients with psychosis. Methods: The OSCAR study is a prospective, 12 month, openlabel, naturalistic study of resource-utilization costs in psychotic patients. A total of 138 subjects with schizophrenia or a related psychotic disorder were enrolled from 5 Canadian centers. This analysis examines the baseline data and explores the univariate and multivariate associations between costs and several clinical and socio-demographic covariates. These covariates include age, gender ethnicity (Caucasian vs. other), education (up to grade 12 vs. beyond grade 12), marital status (single vs. other), family history of schizophrenia (yes/no), ratings of symptoms and functioning (SOFAS: Social and Occupational Functioning Scale, PANSS: Positive and Negative Syndrome , SDS: Sheehan Disability Scale, CGI: Clinical Global Impressions Scale), and history of street-drug, alcohol, marijuana, and cigarette use (each yes/no). The distribution of costs was skewed and was log-transformed for analyses. Data were explored using multivariate regression analysis of covariates. The value of resources consumed was expressed in 2007 Canadian dollars, and is based on non-generic drug costs. Results: Of the 138 subjects enrolled, n = 130 provided complete baseline data. Mean age was 40 years (SD = 13.2, 74% male; 88% Caucasian; 12% married or living common-law). One-fifth (21%) had a known family history of schizophrenia and 65% met criteria for a diagnosis of schizophrenia, 24% for schizoaffective disorder and 11% for other psychosis. Medication at baseline was quetiapine for 34, risperidone for 38 and olanzapine for 48 patients. Mean PANSS and SOFAS scores were 63±18.6 and 59 ± 13.7 respectively and 33% were at least moderately ill according to the CGI. Mean SDS scores were Work/School: 4.8 ± 3.64, Social Life: 5.2±3.29, and Family/Home 4.3 ±3.13.Tobacco, marijuana and street-drug use in the past month was 43%, 12%, and 2% and lifetime use in 69%, 62%, and 35%. Alcohol use in the past month was acknowledged by 42% and 95% reported some lifetime use. The mean baseline costs for resources was $1010 ± 1287 per month (32% for hospitalization and out-patient services, 14% for indirect expenses, 41% for medications, and 13% for other community services). The total costs were highly variable and ranged from $55 to $9653 per month. Increased costs were associated with a lower SOFAS scores, and higher PANSS and SDS scores, as well as with tobacco and street-drug use and finally, with type of medication (each p < 0.05). In the multivariate analysis, type of medication and SOFAS scores remained significant (p < 0.05). Discussion: The current analysis indicates that total resource utilization costs are extremely variable and positively associated with more severe symptoms, lower functioning, substance use, and vary by type of medication used.
doi:10.1016/j.schres.2010.02.483
Lucia Valmaggia1,2,3, Paul McCrone1, Martin Knapp1,4, Matthew Broome5, Paddy Power6, Philip McGuire1,2 1 Institute of Psychiatry, KCL London, London, United Kingdom; 2OASIS, South London and Maudsley Trust London, London, United Kingdom; 3 Maastricht University Maastricht, Maastricht, Netherlands; 4London School of Economics London, London, United Kingdom; 5Warwick University Coventry, Coventry, United Kingdom; 6LEO, South London and Maudsley Trust London, London, United Kingdom Background: Despite the increasing development of early intervention services for psychosis, little is known about their costeffectiveness. Aim: We assessed the cost-effectiveness of Outreach And Support In South London (OASIS), a service for people with an at risk mental state for psychosis. Methods: The costs of OASIS compared to Care As Usual were entered in a decision model and examined for 12- and 24-month periods, using the duration of untreated psychosis and rate of transition to psychosis as key parameters. The costs were calculated on the basis of services used following referral and the impact on employment. Sensitivity analysis was used to test the robustness of all the assumptions made in the model. Results: Over the initial 12 months from presentation the costs of the OASIS intervention were £1872 higher than for Care As Usual. However after 24 months they were £961 less than Care As Usual. Conclusions: This model suggests that services that permit early detection of people at high risk of psychosis may be cost saving. doi:10.1016/j.schres.2010.02.484
Poster 257 THE RELATIONSHIP BETWEEN SOCIAL PROBLEM-SOLVING AND EMOTIONAL REGULATION IN PEOPLE WITH SCHIZOPHRENIA Marianne Ayre1,2, Carmel Loughland2,3,4, Miles Bore1, Amanda Baker2,3 1 HunterNew England Health Newcastle, NSW, Australia; 2Univeristy of Newcastle Newcastle, NSW, Australia; 3Centre fro Brain and Mental Health Research Newcastle, NSW, Australia; 4Schizophrenia Research Institute Sydney, NSW, Australia Background: Deficits in social problem-solving skills have been reported in schizophrenia and are known to impact on vocational performance and interpersonal functioning (Revheim et al., 2006). However, few studies have examined the impact of emotional regulation in people with schizophrenia on social problem-solving ability. Methods: The sample consisted of 114 adults (males, n = 57) with a confirmed diagnose of schizophrenia recruited through the resources of the Australian Schizophrenia Research Bank (ASRB), and a 'healthy' control sample of 146 adult (males n = 22) recruited through registered clubs and education classes, and screened for a history of psychiatric disorders. Participants were administered three questionnaires: The Difficulties in Emotion Regulation Scale (DERS), Social Problem Solving Inventory –Revised (SPSI-R), and the Kessler 10 (K10). Results: Independent t-test showed a significant difference in performance between control and schizophrenia samples on the DERS (t(208.70) = -8.19, p = .00), with the schizophrenia sample