Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA.
BMC Psychiatry. 2012 Dec 5;12:222. doi: 10.1186/1471-244X-12-222.
Little is known about the long-term outcomes for patients with schizophrenia who fail to achieve symptomatic remission. This post-hoc analysis of a 3-year study compared the costs of mental health services and functional outcomes between individuals with schizophrenia who met or did not meet cross-sectional symptom remission at study enrollment.
This post-hoc analysis used data from a large, 3-year prospective, non-interventional observational study of individuals treated for schizophrenia in the United States conducted between July 1997 and September 2003. At study enrollment, individuals were classified as non-remitted or remitted using the Schizophrenia Working Group Definition of symptom remission (8 core symptoms rated as mild or less). Mental health service use was measured using medical records. Costs were based on the sites' medical information systems. Functional outcomes were measured with multiple patient-reported measures and the clinician-rated Quality of Life Scale (QLS). Symptoms were measured using the Positive and Negative Syndrome Scale (PANSS). Outcomes for non-remitted and remitted patients were compared over time using mixed effects models for repeated measures or generalized estimating equations after adjusting for multiple baseline characteristics.
At enrollment, most of the 2,284 study participants (76.1%) did not meet remission criteria. Non-remitted patients had significantly higher PANSS total scores at baseline, a lower likelihood of being Caucasian, a higher likelihood of hospitalization in the previous year, and a greater likelihood of a substance use diagnosis (all p < 0.05). Total mental health costs were significantly higher for non-remitted patients over the 3-year study (p = 0.008). Non-remitted patients were significantly more likely to be victims of crime, exhibit violent behavior, require emergency services, and lack paid employment during the 3-year study (all p < 0.05). Non-remitted patients also had significantly lower scores on the QLS, SF-12 Mental Component Summary Score, and Global Assessment of Functioning during the 3-year study.
In this post-hoc analysis of a 3-year prospective observational study, the failure to achieve symptomatic remission at enrollment was associated with higher subsequent healthcare costs and worse functional outcomes. Further examination of outcomes for schizophrenia patients who fail to achieve remission at initial assessment by their subsequent clinical status is warranted.
对于未能达到症状缓解的精神分裂症患者，其长期预后情况知之甚少。本项针对一项为期 3 年的研究的事后分析比较了在研究入组时符合或不符合横断面症状缓解标准的精神分裂症患者的精神卫生服务成本和功能结局。
本项事后分析使用了一项于 1997 年 7 月至 2003 年 9 月在美国开展的针对精神分裂症患者的为期 3 年、大型、前瞻性、非干预性观察性研究的数据。在研究入组时，使用精神分裂症工作组的症状缓解定义（8 项核心症状评为轻度或更轻）将个体分为未缓解或缓解。通过病历记录来测量精神卫生服务的使用情况。基于现场的医疗信息系统来计算成本。使用多项患者报告的测量和临床医生评定的生活质量量表（QLS）来测量功能结局。使用阳性和阴性综合征量表（PANSS）来测量症状。使用重复测量的混合效应模型或广义估计方程对非缓解和缓解患者的结局进行比较，在调整了多个基线特征后进行。
在入组时，研究的 2284 名参与者中（76.1%）大多数不符合缓解标准。非缓解患者在基线时 PANSS 总分更高，白种人可能性较低，前一年住院可能性较高，物质使用诊断可能性较高（所有 p < 0.05）。在 3 年的研究中，非缓解患者的总精神卫生费用显著更高（p = 0.008）。在 3 年的研究中，非缓解患者更有可能成为犯罪受害者、表现出暴力行为、需要紧急服务以及没有带薪就业（所有 p < 0.05）。在 3 年的研究中，非缓解患者的 QLS、SF-12 心理成分综合评分和总体功能评估得分也显著更低。
在这项为期 3 年的前瞻性观察性研究的事后分析中，在入组时未达到症状缓解与后续更高的医疗保健成本和更差的功能结局相关。需要进一步检查在初始评估时未达到缓解的精神分裂症患者在后续临床状态下的结局。
