Antipsychotic medication for people with first episode schizophrenia: an exploratory economic analysis of alternative treatment algorithms

Available clinical evidence suggests that the newer antipsychotics are similar to conventional antipsychotics for positive symptom control. It has been suggested that they may also be superior for negative symptoms and side effects, but the evidence for this is unclear (Duggan et al, 1999, Kennedy et al, 1999, Srisurapanont et al, 1999, Thornley et al, 1999, Tuunainen and Gilbody, 1999, Wahlbeck et al, 1999). These differences if they exist, may lead to improvements in quality of life and patient satisfaction and subsequent rates of compliance with therapy. If the latter occurs, there may also be improvements in the overall level of symptom control and rate of relapse. Economic evaluations of risperidone suggest that these differences could lead to savings in the use of hospital inpatient care compared to conventional antipsychotics (Guest et al, 1996, Glennie, 1997). The available economic evidence suggests that the use of clozapine has the potential to improve the efficient use of health and social service resources in some patients (Revicki et al, 1990, Davies & Drummond, 1993, Meltzer et al, 1993, Aitchison & Kerwin, 1997, Glennie, 1997, Rosenheck et al, 1997). All of these studies indicate that overall, clozapine is associated with lower rates of hospital inpatient admissions and lower duration of inpatient stay. These are due to earlier discharge from the index inpatient admission and lower rates of relapse. These differences in the use of inpatient care are sufficient to offset the additional costs of purchasing clozapine. However, the designs of all the economic studies raise several issues of concern, such as control for biases, sources of data and methods of data collection, measurement of outcomes, the type and dose regimes of comparator drugs. In addition, the clinical and economic data for these evaluations were collected for a patient population with a long duration of illness and/or who are treatment resistant or intolerant of typical antipsychotic therapy. It is not clear that these are applicable to people with early schizophrenia or those who have not had problems with previous antipsychotics. Patients currently categorised as treatment resistant or treatment intolerant are likely to have a long history of schizophrenia. This is partly due to historical factors, such as the limited number of antipsychotics available, concerns about the safety of clozapine and the restricted use of expensive atypical antipsychotics. These factors may be associated with a relatively poor quality of life and more intensive use of health care services in patients with a longer duration of illness. Any improvements in clinical outcome as a result of a change in antipsychotic may also result in relatively important changes in health status and intensity of ealth service utilisation, compared to those with a recent diagnosis of schizophrenia. In addition, there is some limited evidence that the use of services following entry to a clinical trial is related to the level of resource use prior to entry (Rosenheck et al, 1999). Furthermore, there is a trend to reduce reliance on inpatient or institutional care for people with acute or chronic mental illness. The total number of commissioned hospital bed days for people with mental illness decreased from 14 million to 11.5 million between 1992-3 and 1997-8 and the number of ward attendees fell from 124000 to 93000 (Department of Health, 1998a). Over the same period the number of daily available hospital beds for people with mental illness declined from 47000 to 37000, while the number of outpatient attendances rose from 1.8 million to 2.1 million (HPSS, 1998). Creed et al (1997) suggest that approximately 40% of people with acute episodes of mental illness (including schizophrenia) can be treated by attending psychiatric day hospitals rather then with hospital inpatient admissions. These factors may over estimate the likely value for money of the atypical antipsychotics, in cohorts of people with first episode schizophrenia in the current UK mental health service (Rosenheck et al, 1999). Given the constraints on health and social care budgets, purchasers and providers need to ensure that resources are used efficiently. A variety of guidelines and treatment protocols have been published, or developed for use at a local level to support decisions about the choice of antipsychotic for people with a first episode of schizophrenia. In addition, there are wide variations in the availability and use of the atypical antipsychotics in the UK. Current published literature is not sufficient to address all the economic issues of concern and there is a need for evaluation of the relative efficiency of clozapine and the new antipsychotics. The NHS R&D HTA has funded primary research to assess the relative costs and utility of typical and atypical antipsychotics for people who are resistant to or intolerant of at least two antipsychotics. However, the results of the research will not be available for at least 3 years. In addition, it is also important to assess the value of the new drugs in the context of alternative prescribing guidelines, and for people with a first episode of schizophrenia. This paper presents the results of secondary research to explore the potential economic impact of atypical antipsychotics for people in the context of current clinical guidelines.schizophrenia, QALYs

Geological evaluation of Nimbus vidicon photography, Chesapeake Bay-Blue Ridge

Geological evaluation of Nimbus vidicon photography of Chesapeake Bay to Blue Ridge are

The temperature and humidity relations of various stages in the life history of some calliphorine flies

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Pushing NRQCD to the limit

Lattice NRQCD has proven successful in describing the physics of the upsilon system and B-mesons, though some concerns arise when it is used in simulations of charm quarks. It is certainly possible that the NRQCD expansion is not converging fast enough at this scale. We present some preliminary results on the low-mass breakdown of NRQCD, in particular the behaviour of heavy quarkonium and heavy-light meson spectra as the bare heavy quark mass is decreased well below 1, with the aim of understanding more about the manifestation of this breakdown.Comment: Lattice 99 submission, 3 Pages, 3 eps figure

The classification of slurries and other suspensions using ultrasonic techniques

The attenuation of ultrasonic waves travelling through a liquid containing a suspension of solids is highly dependent on frequency. At low frequencies, where the wavelength is long compared to the particle size, the particles move with the wave with some phase lag which gives rise to a loss component. At high frequencies, where the wavelength can be made comparable to, and ultimately less than the particle diameter, there is still some movement but most of the energy is lost to the wave by scattering. In this work, is attenuation used to characterize the suspension, and is treated in terms of these two components. Absorption which is the conversion of energy into heat and scattering from the actual particles. The former is expressed as loss (dB) per wavelength and increases with frequency, while the latter, in the short wavelength scattering zone simply obstructs the wave

Permutations and foster problems: two puzzles or one?

How are permutation arguments for the inscrutability of reference to be formulated in the context of a Davidsonian truth-theoretic semantics? Davidson (1979) takes these arguments to establish that there are no grounds for favouring a reference scheme that assigns London to ‘Londres’, rather than one that assigns Sydney to that name. We shall see, however, that it is far from clear whether permutation arguments work when set out in the context of the kind of truth-theoretic semantics which Davidson favours. The principle required to make the argument work allows us to resurrect Foster problems against the Davidsonian position. The Foster problems and the permutation inscrutability problems stand or fall together: they are one puzzle, not two

Revenue sharing based on ECPM and video-quality metrics

Advertisement-based revenue generated from content, e.g., videos, hosted on content-sharing sites is typically shared between the content-creator and the content-hosting site based on click-through rates, number of ad impressions, etc. However, user-generated content is of varying quality, e.g., different content items enjoy different levels of viewer attention. A user that watches an advertisement that precedes a video often does not know if the video they are about to watch is the one they’re looking for. This disclosure addresses this problem by quantifying the value that content items bring to their viewer. The creator is paid based on the assessed value. For example, the value of a video may be based partially on the time a user spends viewing it, excluding time spent watching the ad. Basing payments to content creators on content value motivates creators to improve quality of their videos. Content quality also feeds into recommendation engines such that end-users are provided with higher quality of recommendations and search results

SYSTEMS AND METHODS FOR DELIVERING A CONTENT ITEM TO A USER

We propose techniques for delivering a relevant content item to a user. These techniques may render the relevant content item more likely to be delivered as one of the first impressions following the occurrence of a specified event. In some implementations, the event may be the expiration of the user’s free trial period for a subscription service. In some other implementations, the event may be a search query entered by the user. The techniques discussed in this paper may track the number of other content items delivered to a user since the occurrence of the event, and may use this information as the basis for selecting a time at which to deliver the relevant content item to the user

Multi-level donation attribution in social networks

Online fundraising platforms (including social media platforms) encourage donors to publicize their donations via social media to increase visibility for the cause being funded. Credit for social donations is generally given only from one level to the next. For example, credit is given to the user who shares the event of their donation if their sharing led to another donation. However, if the user’s share in turn shared the event of their donations, the original user that started the train of donations is not credited for donations originating beyond the first audience. This disclosure provides techniques such that when a consenting user shares a URL of a donation with a first audience, the user is credited for donations generated not only by the first audience but also by any further audiences that the first audience share the URL with. Users are credited with the total sum of donations they have driven