The Societal Cost of Schizophrenia:An Updated Systematic Review of Cost-of-Illness Studies

BackgroundSchizophrenia imposes a substantial economic burden on society. This updated systematic review aims to collate the latest societal cost of schizophrenia across countries by reviewing recent cost-of-illness (COI) studies.MethodsAn electronic search was conducted across several databases (MEDLINE, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Health Management Information Consortium, and System for Information on Grey Literature) to identify COI studies published from 2016 to 2022. Two independent reviewers selected studies for inclusion. The cost components and estimates reported by included studies were descriptively summarised. All costs were converted to US dollars (2022 values). Study quality was assessed using a checklist adapted from Larg & Moss.ResultsTwenty-four studies were included (5 from the update review and 19 from the original review), of which only two were conducted for low- and middle-income countries (LMICs). Widespread methodological heterogeneity among included studies was observed. The annual societal cost per person varied from US$819 in Nigeria to US$94,587 in Norway. Productivity losses accounted for 32–83% of the overall societal cost, whilst direct healthcare cost made up 11–87%. The reporting quality of included studies varied.ConclusionThis review highlights the substantial economic burden of schizophrenia and a lack of COI studies for LMICs. Recommendations on future research, and good practices on improving the methodological and reporting quality of COI research for schizophrenia are provided

Identificación de las especies: Ommastrephes bartramii, Dosidicus gigas, Sthenoteuthis oualaniensis e Illex argentinus (Ommastrephidae) a través de medidas morfológicas de sus picos

Four oceanic squid species, Ommastrephes bartramii, Dosidicus gigas, Sthenoteuthis oualaniensis and Illex argentinus, not only support important commercial fisheries, but also play a vital role in their marine ecosystems. It is therefore important to identify them in the analyses of their predators’ stomach contents as this can yield critical information on the trophic dynamics of ecosystems. Hard beaks of the four species frequently found in their predators’ stomachs can be used to identify them. In this study, to remove the effect of size differences among individuals, measurements of upper and lower beaks were standardized with an allometric model. A discriminant analysis was carried out to compare morphological differences among the four species and between the sexes for each species. The upper rostral width and upper rostral length showed the greatest interspecific variation in the beak morphological variables of the four Ommastrephidae. The linear discriminant functions of beak morphological variables were developed for the four Ommastraphidae, which resulted in a rate of correct species classification of over 97%. Sexual dimorphism was also found in the beak morphology of O. bartramii and I. argentinus. This study suggests that morphological variables can be used to reliably classify Ommastrephidae at genus level, which can help identify the specie in the stomachs of cephalopod predators. This helps to improve the understanding of the role cephalopods play in their marine ecosystems.Las cuatro especies de calamares: Ommastrephes bartramii, Dosidicus gigas, Sthenoteuthis oualaniensis e Illex argentinus, sometidas a una importante presión pesquera, juegan un papel significativo dentro de los ecosistemas marinos a los que pertenecen. Al ser los picos de estas especies resistentes, las medidas de diversos aspectos de su morfología pueden servir para identificarlas en análisis de contenidos estomacales de sus depredadores. Ello permite obtener una información crucial sobre la dinámica trófica de los ecosistemas. En el presente estudio, las medidas realizadas en los picos superior e inferior de los Ommastrephidae se han normalizado mediante un modelo de crecimiento alométrico, para evitar la influencia del efecto tamaño de los individuos. A continuación, mediante un análisis discriminante, se han estudiado las diferencias morfológicas entre las cuatro especies, así como entre machos y hembras. Las medidas que presentaban mayores variaciones eran la anchura y longitud del rostro superior. Mediante funciones discriminantes lineales de las medidas morfológicas normalizadas de sus picos, se han conseguido clasificar las cuatro especies de Ommastraphidae, con una fiabilidad superior al 97%. Asimismo, a través de sus medidas morfológicas, se ha encontrado un claro dimorfismo sexual en los picos de O. bartramii e I. argentinus. El presente estudio sugiere que las medidas morfológicas pueden ser útiles para clasificar correctamente los Ommastrephidae a nivel de género, y puede permitir identificar la especie en contenidos estomacales de depredadores de cefalópodos, lo cual mejorará el conocimiento del papel de los cefalópodos en los ecosistemas marinos en los que se integran

Stratified medicine in schizophrenia: how accurate would a test of drug response need to be to achieve cost-effective improvements in quality of life?

Objective Stratified medicine refers to the use of tests that predict treatment response to drive treatment decisions for individual patient. The pharmacoeconomic implications of this approach in schizophrenia are unknown. We aimed to assess the cost-effectiveness of a hypothetical stratified medicine algorithm (SMA) compared with treatment as usual (TAU), for patients with schizophrenia who failed a first-line antipsychotic. Methods A decision analytic model with embedded Markov process was constructed, which simulated the health and cost outcomes for patients followed SMA or TAU over a lifetime horizon, from healthcare and social care perspective. In the base-case analysis, sensitivity and specificity of the stratifier were both set as 60%. Extensive sensitivity analyses were conducted to test the impact of uncertainty around the value of important parameters. The primary outcome was the incremental cost per quality-adjusted life year (QALY) gained. Results When both sensitivity and specificity of the stratified test were set at 60%, SMA appeared to be the optimal strategy as it produces more QALYs and incurs lower costs than TAU. This is robust to all scenarios tested. At a willingness-to-pay threshold of £20,000 per QALY, the probability for SMA to be the optimal strategy is 82.4%. Conclusions Our results suggest that use of any stratifier with a sensitivity and specificity over 60% is very likely to be cost-effective comparing to TAU, for psychotic patients who failed a first-line antipsychotic. This finding, however, should be interpreted with caution due to lack of evidence for clozapine as a second-line antipsychotic

Reducing outcome measures in mental health: a systematic review of the methods

Economic and Social Research Council (ESRC) Grant number ES/J500057/1 and South London and Maudsley NHS Trust

Clinical effectiveness and cost-effectiveness of tailored intensive liaison between primary and secondary care to identify individuals at risk of a first psychotic illness (the LEGs study): a cluster-randomised controlled trial.

BACKGROUND: General practitioners are usually the first health professionals to be contacted by people with early signs of psychosis. We aimed to assess whether increased liaison between primary and secondary care improves the clinical effectiveness and cost-effectiveness of detection of people with, or at high risk of developing, a first psychotic illness. METHODS: Our Liaison and Education in General Practices (LEGs) study was a cluster-randomised controlled trial of primary care practices (clusters) in Cambridgeshire and Peterborough, UK. Consenting practices were randomly allocated (1:1) to a 2 year low-intensity intervention (a postal campaign, consisting of biannual guidelines to help identify and refer individuals with early signs of psychosis) or a high-intensity intervention, which additionally included a specialist mental health professional who liaised with every practice and a theory-based educational package. Practices were not masked to group allocation. Practices that did not consent to be randomly assigned comprised a practice-as-usual (PAU) group. The primary outcome was number of referrals of patients at high risk of developing psychosis to the early intervention service per practice site. New referrals were assessed clinically and stratified into those who met criteria for high risk or first-episode psychotic illness (FEP; together: psychosis true positives), and those who did not fulfil such criteria for psychosis (false positives). Referrals from PAU practices were also analysed. We assessed cost-effectiveness with decision analytic modelling in terms of the incremental cost per additional true positive identified. The trial is registered at the ISRCTN registry, number ISRCTN70185866. FINDINGS: Between Dec 22, 2009, and Sept 7, 2010, 54 of 104 eligible practices provided consent and between Feb 16, 2010, and Feb 11, 2011, these practices were randomly allocated to interventions (28 to low intensity and 26 to high intensity); the remaining 50 practices comprised the PAU group. Two high-intensity practices were excluded from the analysis. In the 2 year intervention period, high-intensity practices referred more FEP cases than did low-intensity practices (mean 1.25 [SD 1.2] for high intensity vs 0.7 [0.9] for low intensity; incidence rate ratio [IRR] 1.9, 95% CI 1.05-3.4, p=0.04), although the difference was not statistically significant for individuals at high risk of psychosis (0.9 [1.0] vs 0.5 [1.0]; 2.2, 0.9-5.1, p=0.08). For high risk and FEP combined, high-intensity practices referred both more true-positive (2.2 [1.7] vs 1.1 [1.7]; 2.0, 1.1-3.6, p=0.02) and false-positive (2.3 [2.4] vs 0.9 [1.2]; 2.6, 1.3-5.0, p=0.005) cases. Referral patterns did not differ between low-intensity and PAU practices. Total cost per true-positive referral in the 2 year follow-up was £26,785 in high-intensity practices, £27,840 in low-intensity practices, and £30,007 in PAU practices. INTERPRETATION: This intensive intervention to improve liaison between primary and secondary care for people with early signs of psychosis was clinically and cost effective. FUNDING: UK National Institute for Health Research.The authors acknowledge funding support from a National Institute for Health Research Programme Grant for Applied Research (NIHR PGfAR) programme (RP-PG-0606-1335; “Understanding Causes and Developing Effective Interventions for Schizophrenia and Other Psychoses”) awarded to PBJ. The work forms part of the NIHR Collaboration for Leadership in Applied Health Research & Care East of England (CLAHRC-EoE).This is the final version of the article. It first appeared from Elsevier via http://dx.doi.org/10.1016/S2215-0366(15)00157-

Species identification of <i>Ommastrephes bartramii, Dosidicus gigas, Sthenoteuthis oualaniensis</i> and <i>Illex argentinus</i> (Ommastrephidae) using beak morphological variables

Four oceanic squid species, Ommastrephes bartramii, Dosidicus gigas, Sthenoteuthis oualaniensis and Illex argentinus, not only support important commercial fisheries, but also play a vital role in their marine ecosystems. It is therefore important to identify them in the analyses of their predators’ stomach contents as this can yield critical information on the trophic dynamics of ecosystems. Hard beaks of the four species frequently found in their predators’ stomachs can be used to identify them. In this study, to remove the effect of size differences among individuals, measurements of upper and lower beaks were standardized with an allometric model. A discriminant analysis was carried out to compare morphological differences among the four species and between the sexes for each species. The upper rostral width and upper rostral length showed the greatest interspecific variation in the beak morphological variables of the four Ommastrephidae. The linear discriminant functions of beak morphological variables were developed for the four Ommastraphidae, which resulted in a rate of correct species classification of over 97%. Sexual dimorphism was also found in the beak morphology of O. bartramii and I. argentinus. This study suggests that morphological variables can be used to reliably classify Ommastrephidae at genus level, which can help identify the specie in the stomachs of cephalopod predators. This helps to improve the understanding of the role cephalopods play in their marine ecosystems

Cost-effectiveness of screening tools for identifying depression in early pregnancy: a decision tree model

Background: Although the effectiveness of screening tools for detecting depression in pregnancy has been investigated, there is limited evidence on the cost-effectiveness. This is vital in providing full information to decision makers. This study aimed to explore the cost-effectiveness of different screening tools to identify depression in early pregnancy compared to no screening. Methods: A decision tree was developed to model the identification and treatment pathways of depression from the first antenatal appointment to 3-months postpartum using the Whooley questions, the Edinburgh Postnatal Depression Scale (EPDS) and the Whooley questions followed by the EPDS, compared to no screening. The economic evaluation took an NHS and Personal Social Services perspective. Model parameters were taken from a combination of sources including a cross-sectional survey investigating the diagnostic accuracy of screening tools, and other published literature. Cost-effectiveness was assessed in terms of the incremental cost per quality adjusted life years (QALYs). Cost-effectiveness planes and cost-effectiveness acceptability curves were produced using a net-benefit approach based on Monte Carlo simulations of cost-outcome data. Results: In a 4-way comparison, the Whooley, EPDS and Whooley followed by the EPDS each had a similar probability of being cost-effective at around 30% for willingness to pay values from £20,000–30,000 per QALY compared to around 20% for the no screen option. Conclusions: All three screening approaches tested had a higher probability of being cost-effective than the no-screen option. In the absence of a clear cost-effectiveness advantage for any one of the three screening options, the choice between the screening approaches could be made on other grounds, such as clinical burden of the screening options. Limitations include data availability and short time horizon, thus further research is needed

Anion-induced robust ferroelectricity in sulfurized pseudo-rhombohedral epitaxial BiFeO3 thin films via polarization rotation

Polarization rotation caused by various strains, such as substrate and/or chemical strain, is essential to control the electronic structure and properties of ferroelectric materials. This study proposes anion-induced polarization rotation with chemical strain, which effectively improves ferroelectricity. A method for the sulfurization of BiFeO3 thin films by introducing sulfur anions is presented. The sulfurized films exhibited substantial enhancement in room-temperature ferroelectric polarization through polarization rotation and distortion, with a 170% increase in the remnant polarization from 58 to 100.7 μC cm−2. According to first-principles calculations and the results of X-ray absorption spectroscopy and high-angle annular dark-field scanning transmission electron microscopy, this enhancement arose from the introduction of S atoms driving the re-distribution of the lone-pair electrons of Bi, resulting in the rotation of the polarization state from the [001] direction to the [110] or [111] one. The presented method of anion-driven polarization rotation might enable the improvement of the properties of oxide materials.This work was supported by the National Key Research and Development Program of China (2018YFA0703700, 2017YFE0119700, 2021YFA1400300 and 2018YFA0305700), the National Natural Science Foundation of China (21801013, 51774034, 22271309, 11721404, 11934017, 12261131499, and 51961135107), the Fundamental Research Funds for the Central Universities (FRF-IDRY-19-007 and FRF-TP-19-055A2Z), the National Program for Support of Top-notch Young Professionals, the Young Elite Scientists Sponsorship Program by CAST (2019-2021QNRC), the Beijing Natural Science Foundation (Z200007), and the Chinese Academy of Sciences (XDB33000000). This research used the resources of the Beijing Synchrotron Radiation Facility (1W1A and 4B9B beamlines) of the Chinese Academy of Science.Peer reviewe