Quality of Life and Health Costs: The Feasibility of Cost-Utility Analysis in Schizophrenia

  • A. George AwadEmail author
  • Lakshmi N. P. Voruganti


The high cost of management in schizophrenia, which includes direct and indirect costs, has triggered a good deal of interest in pharmacoeconomics of schizophrenia. The escalating cost of healthcare has led to capping of health services, including mental and psychiatric health. The recent introduction of second-generation antipsychotics has ignited an extensive debate about whether the benefits of such new and expensive medications justify the high acquisition costs. At the center of the pharmacoeconomics debates, health-related quality of life emerged as the optimum and most desirable outcome in the management of schizophrenia. One of the approaches proposed for cost-effectiveness studies capitalized on utility analysis concepts, which incorporates cost and quality of life. This chapter describes our feasibility study of applying utility concepts to schizophrenia, highlighting its merits and limitations.


Antipsychotic Medication Magnitude Estimation Standard Gamble Utility Measure Utility Analysis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Awad AG, Voruganti LNP. Cost-utility analysis in schizophrenia. J Clin Psychiatry. 1999;60 Suppl 3:22–9.PubMedGoogle Scholar
  2. Awad AG, Voruganti LNP. Impact of atypical antipsychotics on quality of life in patients with schizophrenia. CNS Drugs. 2004;18:877–93.CrossRefPubMedGoogle Scholar
  3. Awad AG, Voruganti LNP. Measuring quality of life in patients with schizophrenia – an update. Pharmacoeconomics. 2012;30:183–95.CrossRefPubMedGoogle Scholar
  4. Awad AG, Voruganti LNP. The impact of newer antipsychotics on patient-reported outcomes in schizophrenia. CNS Drugs. 2013;27:625–36.CrossRefPubMedGoogle Scholar
  5. Awad AG, Voruganti LNP, Heselgrave RJ. The aim of antipsychotic medications: what are they and are they being achieved? CNS Drugs. 1995;4:8–16.CrossRefGoogle Scholar
  6. Chouinard G, Albright P. Economic and health state utility determinations for schizophrenic patients treated with Risperidone or haloperidol. J Clin Psychopharmacol. 1997;17:298–307.CrossRefPubMedGoogle Scholar
  7. Davies LM, Drummond MF. The economic burden of schizophrenia. Psychiatr Bull. 1990;14:522–5.CrossRefGoogle Scholar
  8. Drummond MF, Davies L. Economic analysis alongside clinical trials, 1991. Int J Technol Assess Health Care. 1991;7:4561–73.Google Scholar
  9. Drummond M, Stoddart G, Torrence G. Cost-utility analysis. In: Methods for the economic evaluation of health care programs. Oxford: Oxford Medical Publications; 1987. p. 113–38.Google Scholar
  10. Froberg D, Kane R. Methodology for measuring health state preferences I measurement strategy. J Clin Epidemiol. 1989a;42:345–54.CrossRefPubMedGoogle Scholar
  11. Froberg D, Kane R. Methodology for measuring health state preferences II scaling methods. J Clin Epidemiol. 1989b;42:459–71.CrossRefPubMedGoogle Scholar
  12. Froberg D, Kane R. Methodology for measuring health state preferences III population and context effects. J Clin Epidemiol. 1989c;42:585–92.CrossRefPubMedGoogle Scholar
  13. Geddes J, Freemantle N, Harrison P, Bebbington P. Atypical antipsychotics in the treatment of schizophrenia: systemic overview and motor-regression analysis. BMJ. 2000;321:1371–6.CrossRefPubMedPubMedCentralGoogle Scholar
  14. Goeree R, O’Brien BJ, Goering P, Blackhouse G, Agro K, Rhodes A, Watson J. The economic burden of schizophrenia in Canada. Can J Psychiatry. 1999;44:464–72.PubMedGoogle Scholar
  15. Goeree R, Farahati F, Burke N, Blackhouse G, O-Reilly D, Pyne J, Tarride JE. The economic burden of schizophrenia in Canada 2004. Curr Med Res Opin. 2005;21:2017–28.CrossRefPubMedGoogle Scholar
  16. Hansen K, Toumi M, Francois C, Launois R. Pharmacoeconomic modelling in schizophrenia: trap or support for decision makers? Eur J Health Econ. 2006;7:19–29.CrossRefPubMedGoogle Scholar
  17. Hargreaves S. NICE guidelines address social aspects of schizophrenia. BMJ. 2003;29:326.Google Scholar
  18. Jones PE, Barnes TR, Davies L, Dunn G, Lloyd H, Hayhurst K, Murray R, Markwick A, Lewis SW. Randomized controlled trial of the effect on quality of life of second- vs first generation drugs in schizophrenia: cost utility of the latest antipsychotic drugs in schizophrenia study (CUtLASS). Arch Gen Psychiatry. 2006;63:179–1087.CrossRefGoogle Scholar
  19. Knapp M. Costs of schizophrenia. Br J Psychiatry. 1997;171:509–18.CrossRefPubMedGoogle Scholar
  20. Leucht S, Wahelbeck K, Hamman J, Kissling W. New generation antipsychotics vs low-potency conventional antipsychotics: a systematic review and meta-analysis. Lancet. 2003;36:1581–9.CrossRefGoogle Scholar
  21. Lieberman JA, Stroup TS, McEvoy JP, Swartz MS, Rosenheck RA, Perkins DO, Keefe RS, Davis SM, Davis CE, Lebowitz DB, Severe J, Hsiao JK. Clinical antipsychotic trials of intervention effectiveness (CATIE) investigators effectiveness of antipsychotic drugs in patients with schizophrenia. N Engl J Med. 2005;22:1209–23.CrossRefGoogle Scholar
  22. Mangalore R, Knapp M. Cost of schizophrenia in England. J Ment Health Policy Econ. 2007;10:231–48.Google Scholar
  23. Ohlsen R, Taylor D, Tandon K, Aitehison KJ. Returning to the issue of the cost-effectiveness of antipsychotics in the treatment of schizophrenia. Clin Neuropsychiatry. 2008;5:184–94.Google Scholar
  24. Revicki D, Shakespeare A, Kind P. Preferences for schizophrenia-related health states: a comparison of patients, care givers and psychiatrists. Int Clin Psychopharmacol. 1996;11:101–8.PubMedGoogle Scholar
  25. Revicki D, Brown RE, Keller M. Cost-effectiveness of new antidepressants compared with tricyclic antidepressants in managed care settings. J Clin Psychiatry. 1997;58:47–58.CrossRefPubMedGoogle Scholar
  26. Torrence GW. Measurement of health state utilities for economic appraisal. J Health Econ. 1986;5:1–30.CrossRefGoogle Scholar
  27. Von Neuman J, Morgenstern O. Theory of games and economic behaviour. Princeton: Princeton University Press; 1947.Google Scholar
  28. Voruganti LNP, Awad AG, Oyewumi LK, Corfese L, Zirul S, Dhawan R. Assessing health utilities in schizophrenia – a feasibility study. Pharmaceconomics. 2000;17:273–86.CrossRefGoogle Scholar
  29. Wu EQ, Brinbaum HG, Shi L, Ball DE, Kessler RC, Moulis M, Aggarwal J. The economic burden of schizophrenia in the United States 2002. J Clin Psychiatry. 2005;66:1122–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Psychiatry, The Institute of Medical ScienceUniversity of TorontoTorontoCanada
  2. 2.Department of PsychiatryOakville-Trafalgar Memorial HospitalOakvilleCanada

Personalised recommendations