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Identifying patient-relevant endpoints among individuals with schizophrenia: An application of patient-centered health technology assessment

Published online by Cambridge University Press:  06 January 2009

Elizabeth T. Kinter ,
Annette Schmeding ,
Ina Rudolph ,
Susan dosReis  and
John F. P. Bridges
Elizabeth T. Kinter
Affiliation:
Johns Hopkins School of Medicine
Annette Schmeding
Affiliation:
Janssen-Cilag GmbH
Ina Rudolph
Affiliation:
Janssen-Cilag GmbH
Susan dosReis
Affiliation:
Johns Hopkins School of Medicine
John F. P. Bridges
Affiliation:
Johns Hopkins Bloomberg School of Public Health
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Abstract

Objectives: Schizophrenia imposes a great burden on society, and while evaluation should play an important role in informing society's efforts to alleviate these burdens, it is unclear what “endpoints” should be chosen as the objective of such analyses. The objectives of the study were to elicit endpoints directly from patients with schizophrenia, to ascertain whether patients are sufficiently cognoscente to express what endpoints are and are not important to them and to rank the relevant endpoints.

Methods: We applied principles of patient-centered health technology assessment to identify and value endpoints from the patient's perspective. Focus groups were conducted to elicit endpoints, using interpretive phenomalogical analysis (IPA) to guide the collection, analysis and interpretation of data. Patient interviews were subsequently used to elicit patient preference over endpoints. Respondents were presented with cards outlining the endpoints and asked to remove irrelevant cards. They where then asked to identify and rank their five most relevant endpoints in order of importance. Interviews were recorded for the purposed of triangulation, and data was analyzed using descriptive statistics. Patients were recruited from five geographically diverse cities in Germany. Eligibility required a diagnosis of schizophrenia by a physician and treatment with an antipsychotic medication for at least one year. Respondents were excluded if they were experiencing an acute episode.

Results: Thirteen endpoints emerged as important from the focus groups spanning side-effects, functional status, processes of care and clinical outcomes. Respondents could clearly identify relevant and irrelevant endpoints, and rank which factors were important to them. Triangulation between field notes of the ranking exercise and recordings confirmed that rankings were not arbitrary, but justified from the respondents' point of view.

Conclusions: Patients with schizophrenia can express preferences over endpoints. Our results show that qualitative methods such as IPA can be used to identify factors, but ranking exercises provide a more robust method for ranking the importance of endpoints. Future research involving patients with schizophrenia ranking outcomes is needed to identify variations across patients and methods such as conjoint analysis could prove beneficial in identifying acceptable tradeoffs across endpoints.

Keywords

SchizophreniaPatient-preferencesPatient endpointsHTAHealth technology assessment
Type
General Essays
Information
International Journal of Technology Assessment in Health Care , Volume 25 , Issue 1 , January 2009 , pp. 35 - 41
Copyright
Copyright © Cambridge University Press 2009

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References

REFERENCES

1. Agency for Healthcare Research and Quality. National healthcare quality report. Rockville, MD: Agency for Healthcare Research and Quality; 2006.Google Scholar
2. Baker, R, Thompson, C, Mannion, R. Q methodology in health economics. J Health Serv Res Policy. 2006;11:38–45.CrossRefGoogle ScholarPubMed
3. Bandelow, B, Muller, P, Gaebel, W, et al. Depressive syndromes in schizophrenic patients after discharge from hospital. ANI Study Group Berlin, Dusseldorf, Gottingen, Munich. Eur Arch Psychiatry Clin Neurosci. 1990;240:113–120.CrossRefGoogle Scholar
4. Bastian, H. Speaking up for ourselves. The evolution of consumer advocacy in health care. Int J Technol Assess Health Care. 1998;14:3–23.CrossRefGoogle ScholarPubMed
5. Bridges, J, Jones, C. Patient-based health technology assessment: A vision for the future. Int J Technol Assess Health Care. 2007;23:30–35.CrossRefGoogle ScholarPubMed
6. Bull, SA, Hu, XH, Hunkeler, EM, et al. Discontinuation of use and switching of antidepressants: Influence of patient-physician communication. JAMA. 2002;288:1403–1409.CrossRefGoogle ScholarPubMed
7. Chapman, E, Smith, R. Interpretative phenomenological analysis and the new genetics. J Health Psychol. 2002;7: 125–130.Google Scholar
8. Draborg, E, Andersen, C.K. What influences the choice of assessment methods in health technology assessments? Statistical analysis of international health technology assessments from 1989 to 2002. Int J Technol Assess Health Care. 2006;22:19–25.CrossRefGoogle Scholar
9. Duckworth, K. Schizophrenia. In. About mental illness. NAMI. 2007; February: http://www.nami.org/Template.cfm?Section=By_Illness&Template=/TaggedPage/TaggedPage-Display.cfm&TPLID=54&ContentID=23036. Accessed September 10, 2008.Google Scholar
10. Gemeinsamer Bundesausschuss. Gesetzlicher Auftrag und Arbeitsweise. 2008. http://www.g-ba.de/institution/auftrag/.Google Scholar
11. Goldberg, TE. Some fairly obvious distinctions between schizophrenia and bipolar disorder. Schizophr Res. 1999;39:127–132.CrossRefGoogle ScholarPubMed
12. Hansen, H. The patient. In: Kristensen, FB, Sigmund, H, eds. The health technology assessment handbook. Copenhagen: Danish Centre for Health Technology Assessment, National Board of Health; 2007:104–114.Google Scholar
13. Haycox, A. Pharmacoeconomics of long-acting risperidone: Results and validity of cost-effectiveness models. Pharmacoeconomics. 2005;23 (Suppl):3–16.Google Scholar
14. Hogan, TP, Awad, AG, Eastwood, R. A self-report scale predictive of drug compliance in schizophrenics: Reliability and discriminative validity. Psychol Med. 1983;13:177–183.Google Scholar
15. Institute für Qualität und Wirtschaflichkeit im Gesundheitswesen (IQWiG). Methods version 1.0. Cologne, Germany. http://www.iqwig.de/download/Methods_of_the_Institute.pdf. Accessed September 9, 2005.Google Scholar
16. Institute für Qualität und Wirtschaflichkeit im Gesundheitswesen (IQWiG). Allgemeine Methoden version 3.0. Cologne, Germany. http://www.iqwig.de/download/IQWiG_Methoden_Version_3_0.pdf. Accessed May 27, 2008.Google Scholar
17. Knapp, M, Chisholm, D, Leese, M, et al. Comparing patterns and costs of schizophrenia care in five European countries: The EPSILON study. European psychiatric services: Inputs linked to outcome domains and needs. Acta Psychiatr Scand. 2002;105:42–54.CrossRefGoogle ScholarPubMed
18. Lecrubier, Y, Perry, R, Milligan, G, et al. Physician observations and perceptions of positive and negative symptoms of schizophrenia: A multinational, cross-sectional survey. Eur Psychiatry. 2007;22:371–379.Google Scholar
19. Lieberman, JA, Stroup, TS, McEvoy, JP, et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med. 2005;353:1209–1223.Google Scholar
20. Manschreck, TC, Boshes, RA. The CATIE Schizophrenia Trial: Results, impact, controversy. Harv Rev Psychiatry. 2007;5:245–258.Google Scholar
21. Maurer, Y, Dittrich, A. [Comparison of psychiatrist's rating and self rating of schizophrenic patients (author's transl)]. Pharmakopsychiatr Neuropsychopharmakol. 1979;12:375–382.Google Scholar
22. McEvoy, JP, Lieberman, JA, Stroup, TS, et al. Effectiveness of clozapine versus olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia who did not respond to prior atypical antipsychotic treatment. Am J Psychiatry. 2006;163:600–610.CrossRefGoogle Scholar
23. Mooney, G. What else do we want from our health services? Soc Sci Med. 1994;39:151–154.CrossRefGoogle ScholarPubMed
24. Naber, D, Karow, A. Good tolerability equals good results: The patient's perspective. Eur Neuropsychopharmacol. 2001;11 (Suppl 4):S391–S396.Google Scholar
25. National Health Service. Patient and public involvement in the new NHS. Leeds: Department of Health; 1999.Google Scholar
26. Pyne, JM, Labbate, C. Ranking of outcome domains for use in real-time outcomes feedback laboratory by patients with schizophrenia. J Nerv Ment Dis. 2008. 196:336–339.CrossRefGoogle ScholarPubMed
27. Rosenheck, R, Stroup, S, Keefe, R, et al. Measuring outcome priorities and preferences in people with schizophrenia. Br J Psychiatry. 2005;187:529–536.Google Scholar
28. Ryan, M. Using conjoint analysis to take account of patient preferences and go beyond health outcomes: An application to in vitro fertilization. Soc Sci Med. 1999;48:535–546.Google Scholar
29. Thomas, P. The stable patient with schizophrenia–from antipsychotic effectiveness to adherence. Eur Neuropsychopharmacol. 2007;17 (Suppl 2):S115-S122.CrossRefGoogle ScholarPubMed
30. Vogt, F, Schwappach, DL, Bridges, JF. Accounting for tastes: A German perspective on the inclusion of patient preferences in healthcare. Pharmacoeconomics. 2006;24:419–423.Google Scholar
31. Wu, EQ, Birnbaum, HG, Shi, L et al. , The economic burden of schizophrenia in the United States in 2002. J Clin Psychiatry. 2005;66:1122–1129.CrossRefGoogle ScholarPubMed