Skip to main content
SpringerLink
Log in

Measuring the Effect of Treatment on Quality of Life in Patients with Schizophrenia

Focus on Utility-Based Measures

  • Review Article
  • Published:
CNS Drugs Aims and scope Submit manuscript

Abstract

This paper reviews utility-based measures of health-related quality-of-life outcomes that might be used in clinical trials involving patients with schizophrenia. Utility-based quality-of-life data can facilitate decision-making regarding allocation of shrinking resources. Comprehensive measures can help evaluate treatments that may provide benefits in one dimension of quality of life, while providing no benefit or having negative effects in other dimensions of quality of life. This review suggests that the measurement of outcome in mental health clinical trials should include utility-based measures (e.g. the Quality of Well-Being scale, EuroQOL) which integrate a variety of outcome dimensions and combine them into a single preference weighted index.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Wyatt RJ, Henter I, Leary MC, et al. An economic evaluation of schizophrenia — 1991. Soc Psychiatry Psychiatr Epidemiol 1995; 30: 196–205

    PubMed  CAS  Google Scholar 

  2. Cuffel BJ, Jeste DV, Halpain M, et al. Treatment costs and use of community mental health services for schizophrenia by age-cohorts. Am J Psychiatry 1996; 153: 870–6

    PubMed  CAS  Google Scholar 

  3. Jeste DV, Caligiuri MR. Tardive dyskinesia. Schizophr Bull 1993; 19(2): 303–15

    PubMed  CAS  Google Scholar 

  4. Lehman AF, Possidente S, Hawker F. The quality of life of chronic patients in a state hospital and in community residences. Hosp Community Psychiatry 1986; 37: 901–7

    PubMed  CAS  Google Scholar 

  5. Simpson CJ, Hyde CE, Farragher EB. The chronically mentally ill in community facilities: a study of quality of life. Br J Psychiatry 1989; 154: 77–82

    Article  PubMed  CAS  Google Scholar 

  6. Collins EJ, Hogan TP, Himansu D. Measurement of therapeutic response in schizophrenia. A critical survey. Schizophr Res 1991; 5: 249–53

    Article  PubMed  CAS  Google Scholar 

  7. Revicki RA, Murray M. Assessing health-related quality of life outcomes of drug treatments for psychiatric disorders. CNS Drugs 1994; 1(6): 465–75

    Article  Google Scholar 

  8. Hogarty GE, Kornblith SJ, Greenwald D, et al. Three-year trials of personal therapy among schizophrenic patients living with or independent of family, I: description of study and effects in relapse rates. Am J Psychiatry 1997; 154(11): 1504–13

    PubMed  CAS  Google Scholar 

  9. Hogarty GE, Greenwald D, Ulrich RF, et al. Three-year trials of personal therapy among schizophrenic patients living with or independent of family, II: effects on adjustments of patients. Am J Psychiatry 1997; 154: 1514–24

    PubMed  CAS  Google Scholar 

  10. Liberman RP. Psychosocial treatments for schizophrenia. Psychiatry 1996; 57: 104–14

    Google Scholar 

  11. Penn DL, Mueser KT. Research update on the psychosocial treatment of schizophrenia. Am J Psychiatry 1996; 153: 607–17

    PubMed  CAS  Google Scholar 

  12. Anthony WA, Cohen MR, Vitalo R. The measurement of rehabilitation outcome. Schizophr Bull 1978; 4: 365–83

    Google Scholar 

  13. Goldstein MJ, Rodnick EH, Evans JR, et al. Drug and family therapy in aftercare of acute schizophrenics. Arch Gen Psychiatry 1978; 35: 1169–77

    Article  PubMed  CAS  Google Scholar 

  14. Liberman RP, Mueser KT, Wallace CJ. Social skills training for schizophrenic individuals at risk for relapse. Am J Psychiatry 1986; 143: 522–6

    Google Scholar 

  15. Hogarty GE. Resistance of schizophrenic patients to social and vocational rehabilitation. In: Denker SJ, Kalhanek F, editors. Treatment resistance in schizophrenia. Braunsweig, Wiesbaden: Vieweg Verlag, 1988

    Google Scholar 

  16. Atkinson JM, Coia DA, Gilmour WH, et al. The impact of education groups for people with schizophrenia on social functioning and quality of life. BrJ Psychiatry 1996; 168: 199–204

    Article  CAS  Google Scholar 

  17. Browne S, Roe M, Lane A, et al. A preliminary report on the effects of a psychosocial and educative rehabilitation programme on quality of life and symptomatology in schizophrenia. Eur Psychiatry 1996; 11: 386–9

    Article  PubMed  CAS  Google Scholar 

  18. Barry MM, Crosby C. Quality of life as an evaluative measure in assessing the impact of community care on people with long-term psychiatric disorders. Br J Psychiatry 1996; 168: 210–6

    Article  PubMed  CAS  Google Scholar 

  19. Jolley AG, Hirsch SR, Morrision E, et al. Trial of brief intermittent neuroleptic prophylaxis for selected schizophrenia outpatients: clinical and social outcomes at two years. BMJ 1990; 301: 837–42

    Article  PubMed  CAS  Google Scholar 

  20. Franz M, Lis S, Pluddemann K, et al. Conventional versus atypical neuroleptics: subjective quality of life in schizophrenic patients. Br J Psychiatry 1997; 170: 422–5

    Article  PubMed  CAS  Google Scholar 

  21. Meltzer HY, Burnett S, Bastani B, et al. Effects of six months of clozapine treatment on the quality of life of chronic schizophrenic patients. Hosp Community Psychiatry 1990; 41(8): 892–7

    PubMed  CAS  Google Scholar 

  22. Galletly C, Clark CR, McFarlane AC, et al. Relationship between changes in symptom ratings, neuropsychological test performance and quality of life in schizophrenic patients treated with clozapine. Psychiatry Res 1997; 72: 161–6

    Article  PubMed  CAS  Google Scholar 

  23. Hamilton SH, Revicki DA, Genduso LA, et al. Olanzapine versus placebo and haloperidol: quality of life and efficacy results of the North American double-blind trial. Neuropsy-chopharmacology 1998; 18: 41–9

    Article  CAS  Google Scholar 

  24. Revicki D, Haley S, Hamilton L, et al. Quality of life outcomes for olanzapine and haloperidol treatment for schizophrenia and other psychotic disorders: results of an international randomized clinical trail [abstract]. Qual Life Res 1997; 6: 708

    Article  Google Scholar 

  25. Lehman AF. Quality of life core version: manual. University of Maryland School of Medicine, 1991

  26. Ware JE, Snow KK, Kosinski M, et al. SF-36 Health survey: manual and interpretation guide. Boston (MA): Nimrod Press, 1993

    Google Scholar 

  27. Foster RH, Goa KL. Risperidone: a pharmacoeconomic review of its use in schizophrenia. Pharmacoeconomics 1998; 14(1): 97–133

    Article  PubMed  CAS  Google Scholar 

  28. Aronson SM. Cost-effectiveness and quality of life in psychosis: the pharmacoeconomics of risperidone. Clin Ther 1997; 19: 139–47

    Article  PubMed  CAS  Google Scholar 

  29. Glazer WM. The impact of managed care systems on relapse prevention and quality of life for patients with schizophrenia. Eur Neuropsychopharmacol 1996; 6 Suppl. 2: S35–9

    Article  PubMed  Google Scholar 

  30. Williams R, Dickson RA. Economics of schizophrenia. Can J Psychiatry 1995; 40(7 Suppl. 2): S60–70

    PubMed  CAS  Google Scholar 

  31. Awad AG. Quality of life of schizophrenic patients on medications and implications for new drug trials. Hosp Community Psychiatry 1992; 43: 262–5

    PubMed  CAS  Google Scholar 

  32. Awad AG, Voruganti LNP, Heslegrave RJ. Measuring quality of life in patients with schizophrenia. Pharmacoeconomics 1997; 11: 32–47

    Article  PubMed  CAS  Google Scholar 

  33. Keks NA. Impact of newer antipsychotics on outcomes in schizophrenia. Clin Ther 1997; 19: 148–58

    Article  PubMed  CAS  Google Scholar 

  34. Larsen EB, Gerlach J. Subjective experience of treatment, side effects, mental state and quality of life in chronic schizophrenia out-patients treated with depot neuroleptics. Acta Psychiatrica Scand 1996; 93: 381–8

    Article  CAS  Google Scholar 

  35. Awad AG, Hogan TP. Subjective response to neuroleptics and the quality of life: implications for treatment outcome. Acta Psychiatrica Scand 1994; 89 Suppl. 380: 27–32

    Article  Google Scholar 

  36. Weiden P, Rapkin B, Mott T, et al. Rating of medication influences (ROMI) scale in schizophrenia. Schizophr Bull 1994; 20(2): 297–310

    PubMed  CAS  Google Scholar 

  37. Lawton MP. The varieties of wellbeing. Exp Aging Res 1983; Summer (no. 2): 65-72

  38. Lawton MP. A multidimensional view of quality of life in frail elders. In: Birren JE, Lubben JE, Rowe JC, et al., editors. The concept and measurement of quality of life in the frail elderly. San Diego (CA): Academic Press, 1991: 3–27

    Google Scholar 

  39. Field MJ, Gold MR. Summarizing population health. Washington (DC): Institute of Medicine

  40. World Health Organization. Constitution of the World Health Organization. Geneva: WHO Basic Documents, 1948

    Google Scholar 

  41. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): conceptual framework and items selection. Med Care 1992; 30; 473–83

    Article  PubMed  Google Scholar 

  42. Bellack AS, Mueser KT, Wade J, et al. The ability of schizophrenics to perceive and cope with negative affect. Br J Psychiatry 1992; 160: 473–80

    Article  PubMed  CAS  Google Scholar 

  43. Klapow JC, Evans J, Patterson TL, et al. The direct assessment of function in older schizophrenia patients. Am J Psychiatry 1997; 154: 1022–4

    PubMed  CAS  Google Scholar 

  44. Patterson TL, Kaplan RM, Grant I, et al. Quality of well-being in late-life psychosis. Psychiatry Res 1996; 63(2-3): 169–81

    Article  PubMed  CAS  Google Scholar 

  45. Patterson TL, Shaw W, Semple SJ, et al. Health related quality of life in older patients with schizophrenia and other psychoses: relationship among psychosocial and psychiatric factors. Int J Geriatr Psychiatry 1997; 12: 452–61

    Article  PubMed  CAS  Google Scholar 

  46. Gilson BS, Gilson JS, Bergner M, et al. The sickness impact profile: development of an outcome measure of health care. Am J Public Health 1975; 65: 1304–10

    Article  PubMed  CAS  Google Scholar 

  47. Hays RD, Sherbourne CD, Mazel RM. The Rand 36-item health survey 1.0. Health Econ 1993; 2(3): 217–27

    Article  PubMed  CAS  Google Scholar 

  48. Ganz PA, Haskell CM, Giglin RA, et al. Estimating the quality-of-life in a clinical trial of patients with metastatic lung cancer using the Karnofsky Performance Status and the Functional Living Index. Cancer 1988; 61: 849–56

    Article  PubMed  CAS  Google Scholar 

  49. Weissman MM, Paykel ES. The depressed woman: a study of social relationships. Chicago (IL): University of Chicago Press, 1974

    Google Scholar 

  50. Patterson TL, Semple SJ, Shaw WS, et al. Self-reported social functioning among older patients with schizophrenia. Schizophr Res 1997; 27: 199–210

    Article  PubMed  CAS  Google Scholar 

  51. Andreasen NC, Olsen S. Negative vs positive schizophrenia. Arch Gen Psychiatry 1982; 39; 789–94

    Article  PubMed  CAS  Google Scholar 

  52. Kaplan RM. Quality of life assessment for cost/utility studies in cancer. Cancer Treat Rev 1993; 19 Suppl. A: 85–96

    Article  PubMed  Google Scholar 

  53. Kaplan RM, Anderson JP. A general health policy model: update and applications. Health Serv Res 1988; 23: 203–34

    PubMed  CAS  Google Scholar 

  54. Kaplan RM, Anderson JP. The quality of well-being scale: rationale for a single quality of life index. In: Walker SR, Rosser R, editors. Quality of life: assessment and application. London: MTP Press, 1988: 51–77

    Google Scholar 

  55. Gold MR, Siegel JE, Russel LB, et al. Cost-effectiveness in health and medicine. New York (NY): Oxford University Press, 1996

    Google Scholar 

  56. Russell L. Is prevention better than cure? Washington (DC): The Brookings Institution, 1986

    Google Scholar 

  57. Gold M, Franks P, Erickson P. Assessing the health of the nation. The predictive validity of a preference-based measure and self-rated health. Med Care 1996; 34(2): 163–77

    Article  PubMed  CAS  Google Scholar 

  58. World Health Organization. Health Promotion. A discussion document on the concepts and principles. ICP/HRS 602(m01). Copenhagen: WHO Regional Office of Europe, 1984

    Google Scholar 

  59. Kaplan RM, Anderson JP, Ganiats TG. The quality of well-being scale: rationale for a single quality of life index. In: Walker SR, Rosser RM, editors. Quality of life assessment: key issues in the 1990s. London: Kluwer Academic Publishers, 1993: 65–94

    Chapter  Google Scholar 

  60. Kassirer JP, Angell M. The journal’s policy on cost-effectiveness analyses. N Engl J Med 1994; 331(10): 669–70

    Article  PubMed  CAS  Google Scholar 

  61. Dupuy HJ. The psychological general well-being (PGWB) index. In: Wenger NK, Mattson ME, Furberg CD, et al., editors. Assessment of quality of life in clinical trials of cardiovascular therapies. New York (NY): Le Jacq, 1984: 170–83

    Google Scholar 

  62. Ware JE. Evaluating measures of general health concepts for use in clinical trials. In: Quality of life assessment: practice, problems and promise. 93rd ed. Washington (DC): Superintendent of Documents, U.S. Government Printing Office, 1993: 51–63

    Google Scholar 

  63. World Health Organization. International classification of impairments, disabilities, and handicaps. Geneva: World Health Organization, 1984

    Google Scholar 

  64. Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study. Lancet 1997; 349(9064): 1498–504

    Article  PubMed  CAS  Google Scholar 

  65. World Bank. World development report: investing in health. New York (NY): Oxford University Press, 1993

    Google Scholar 

  66. Spilker B, editor. Quality of life and pharmacoeconomics in clinical trials. 2nd ed. Philadelphia (PA): Lippincott-Raven, 1996

  67. Torrance GW, Feeny DH, Furlong WJ, et al. Multiattribute utility function for a comprehensive health status classification system. Health Utilities Index Mark 2. Med Care 1996; 34(7): 702–22

    Article  PubMed  CAS  Google Scholar 

  68. EuroQOL Group. EuroQOL — a new facility for the measurement of health-related quality of life. Health Policy 1990; 16: 199–208

    Article  Google Scholar 

  69. Hadorn DC, Uebersax J. Large-scale health outcomes evaluation: how should quality of life be measured? Pt I. Calibration of a brief questionnaire and a search for preference subgroups. J Clin Epidemiol 1995; 48(5): 607–18

    Article  PubMed  CAS  Google Scholar 

  70. Hadorn DC, Sorensen J, Holte J. Large-scale health outcomes evaluation: how should quality of life be measured? Pt II. Questionnaire validation in a cohort of patients with advanced cancer. J Clin Epidemiol 1995; 48(5): 619–29

    Article  PubMed  CAS  Google Scholar 

  71. Torrance GW, Feeny D. Utilities in quality-adjusted life years. Int J Technol Assess Health Care 1989; 5: 559–75

    Article  PubMed  CAS  Google Scholar 

  72. Feeny D, Furlong W, Boyle M, et al. Multi-attribute health status classification systems: health utilities index. Pharmacoeconomics 1995; 7(6): 490–502

    Article  PubMed  CAS  Google Scholar 

  73. Erickson P, Kendall EA, Anderson JP, et al. Using composite health status measures to asses the nation’s health. Med Care 1989; 27 Suppl. 3: S66–76

    Article  PubMed  CAS  Google Scholar 

  74. Kaplan RM. Application of a general health policy model in the American health care crisis. J R Soc Med 1993; 86: 277–81

    PubMed  CAS  Google Scholar 

  75. Kerner DN, Patterson TL, Grant I, et al. Validity of the quality of well-being scale for patients with Alzheimer’s disease. J Aging Health 1998; 10(1): 44–61

    Article  PubMed  CAS  Google Scholar 

  76. Kaplan RM. Hippocratic predicament: affordability, access, and accountability in health care. San Diego (CA): Academic Press, 1993

    Google Scholar 

  77. Kaplan RM. Value judgment in the Oregon Medicaid Experiment. Med Care 1994; 32(10): 975–88

    Article  PubMed  CAS  Google Scholar 

  78. Brazier J, Jones N, Kind P. Testing the validity of the Euroqol and comparing it with the SF-36 health survey questionnaire. Qual Life Res 1993; 2(3): 169–80

    Article  PubMed  CAS  Google Scholar 

  79. Fryback DG, Lawrence WF, Martin PA, et al. Predicting quality of well-being scores from the SF-36: results from the Beaver Dam Health Outcomes Study. Med Decis Mak 1997; 17(1): 1–9

    Article  CAS  Google Scholar 

  80. Sturm R, Wells KB. How can care for depression become more cost-effective? JAMA 1995; 273: 51–8

    Article  PubMed  CAS  Google Scholar 

  81. Spitzer RL, Williams JBW, Gibbon M, et al. User’s Guide for the Structured Clinical Interview for DSM-III-R. Washington (DC): American Psychiatric Press, 1990

    Google Scholar 

  82. Depue RA, Dubicki MD, McCarthy T. Differential recovery of intellectual, associational, and psychophysiological functioning in withdrawn and active schizophrenics. J Abnorm Psychol 1975; 84: 325–30

    Article  PubMed  CAS  Google Scholar 

  83. Derogatis LR, Lipman RS, Rickeis K, et al. The Hopkins symptom checklist (HSCL): a self-report symptom inventory. Behav Sci 1974; 19: 1–15

    Article  PubMed  CAS  Google Scholar 

  84. Pyne JM, Patterson TL, Kaplan RM, et al. Quality of life assessment for patients with major depression. Psychiatr Serv 1997; 48(2): 224–30

    PubMed  CAS  Google Scholar 

  85. Pyne JM, Patterson TL, Kaplan RM, et al. Preliminary longitudinal assessment of quality of life in patients with major depression. Psychopharmacol Bull 1997; 33(1): 23–9

    PubMed  CAS  Google Scholar 

  86. Rubin HC, Patterson TL, Atkinson JH, et al. Tracking effects of depression on life quality in HIV. Second international conference on biopsychosocial aspects of HIV infection, Brighton, UK: Jul 8, 1994

  87. Lenert LA, Morss S, Goldstein MK, et al. Measurement of the validity and utility elicitations performed by computerized interview. Med Care 1997; 35(9): 915–20

    Article  PubMed  CAS  Google Scholar 

  88. Neumann PJ, Johannesson M. From principle to public policy: using cost-effectiveness analysis. Health Affairs 1994; 13(3): 206–14

    Article  PubMed  CAS  Google Scholar 

  89. Detsky A. Guidelines for economic analysis of pharmaceutical products. Ontario Ministry of Health. Toronto: Drug Programme Branch, Ministry of Health, 1991

    Google Scholar 

  90. Williams A. The importance of quality of life in policy decisions. In: Walker S, Rosser R, editors. Quality of life: assessment and application. London: MTP Press, 1988; 279–90

    Google Scholar 

  91. Oregon Health Services Commission Office of Health Policy. Prioritization of health services: a report to the governor and legislature. Oregon Health Services Commission Office of Health Policy, Department of Human Resources, 1995

  92. Andreasen N. Assessment issues and the cost of schizophrenia. Schizophr Bull 1991; 17(3): 475–81

    PubMed  CAS  Google Scholar 

  93. Moscarelli M. Health and economic evaluation in schizophrenia: implications for health policies. Acta Psychiatr Scand 1994; Suppl. 382: 84–8

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, California, 92093-0860, USA

    Thomas L. Patterson, Robert M. Kaplan & Dilip V. Jeste

  2. Department of Veterans Affairs Medical Center, San Diego, California, USA

    Thomas L. Patterson, Robert M. Kaplan & Dilip V. Jeste

Authors
  1. Thomas L. Patterson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert M. Kaplan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dilip V. Jeste
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thomas L. Patterson.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Patterson, T.L., Kaplan, R.M. & Jeste, D.V. Measuring the Effect of Treatment on Quality of Life in Patients with Schizophrenia. CNS Drugs 12, 49–64 (1999). https://doi.org/10.2165/00023210-199912010-00005

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00023210-199912010-00005

Keywords

Search

Navigation