Measurement of quality of life in schizophrenia: a comparison of two scales.

BACKGROUND: People with schizophrenia have an impaired quality of life (QoL), and various QoL assessment scales are available. However it is not clear which scale should be used in different situations. We aimed to compare a patient-rated subjective QoL scale with an observer-rated QoL scale by measuring their degree of correlation and their respective associative profiles with outcome measures. METHOD: Patients of the UK Schizophrenia Care and Assessment Program completed a patient-rated QoL questionnaire (MANSA). Research staff completed the observer-rated QoL tool (QLS) as part of an assessment of symptomatology and functioning. RESULTS: The two QoL tools were moderately positively correlated (r = 0.39). Both scales were negatively correlated with positive and negative symptoms of schizophrenia and depressive symptoms, and positively correlated with functioning scores. However the two scales were influenced by different factors. The patient-rated QoL was more significantly influenced by depressive symptoms, and the observer-rated QoL was more heavily influenced by negative symptoms. CONCLUSIONS: Patient-rated and observer-rated QoL are moderately related, with a number of joint determinants, but the former is sensitive to depressive influences, whilst the latter is sensitive to the negative symptomatology of schizophrenia.

A randomized controlled trial of the use of self-help materials in addition to standard general practice treatment of depression compared to standard treatment alone.

BACKGROUND: The purpose of the study was to examine whether the addition of a brief individual self-help package to standard primary-care treatment of depression with antidepressants is associated with any additional improvements in clinical outcome. METHOD: Individuals with major depressive disorder who were prescribed an antidepressant were recruited through their general practitioner (GP) and allocated randomly to standard treatment alone or standard treatment plus self-help. Assessments of symptoms, social adjustment, global functioning, satisfaction with treatment and knowledge about the management of the disorder were completed at three time points over 26 weeks. RESULTS: One hundred and twelve individuals agreed to participate and 96 met criteria for inclusion in the randomized controlled trial. Subjects in both treatment conditions improved substantially over the study period; the mean Beck Depression Inventory (BDI) score fell from 27.3 to 13.9 in the intention-to-treat analysis. There were no between group differences in outcome on any of the primary outcome measures, nor did these approach even marginal significance. Patients and GPs were highly satisfied with the self-help programme, and the intervention as compared to the control group reported significantly greater improvements in knowledge about depression and satisfaction with information received about depression. CONCLUSIONS: An individualized self-help package improved perceived knowledge about depression but did not have identifiable effects on outcome when offered to patients treated in primary care. The study was sufficiently well powered to detect relatively small effects.

Economic evaluation of gemcitabine in the treatment of pancreatic cancer in the UK.

This study evaluated the cost-effectiveness of gemcitabine as first-line treatment for pancreatic cancer in the UK. Outcomes data and costs based on utilisation data were analysed from a previously reported clinical trial. Outcome measures were average and incremental costs of survival gain, progression-free survival gain and clinical benefit response (a symptom-based measure) for gemcitabine compared with 5-fluorouracil (5-FU) via intravenous injection in the first-line setting. The incremental costs per life-year and per progression-free life-year were pounds sterling 12,206 and pounds sterling 19,888, respectively, for gemcitabine over 5-FU therapy. The incremental cost per clinical benefit responder for gemcitabine over 5-FU was pounds sterling 12,142. If 5-FU was administered by 24-h continuous infusion rather than being given once a week, treatment costs were estimated to be more expensive. The resulting incremental cost per life-year gained with gemcitabine falls to pounds sterling 8,831. Sensitivity analyses (including alterations based on statistical variance) demonstrated that the results were robust and relatively insensitive to variations in key parameters. Gemcitabine is thus a cost-effective therapy for patients with pancreatic cancer and cost per life-year compares favourably with other technologies funded by the National Health Service in the UK.