Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

Articles   |    
Psychiatrists’ Judgments About Antipsychotic Benefit and Risk Outcomes and Formulation in Schizophrenia Treatment
Michael A. Markowitz, M.D., M.S.P.H.; Bennett S. Levitan, M.D., Ph.D.; Ateesha F. Mohamed, M.A.; F. R. Johnson, Ph.D.; John F. P. Bridges, Ph.D.; Larry Alphs, M.D., Ph.D.; Leslie Citrome, M.D., M.P.H.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300290
View Author and Article Information

When this work was done, Dr. Markowitz was with Janssen Scientific Affairs, LLC, Titusville, New Jersey, where Dr. Alphs is affiliated. Dr. Markowitz is now with the CNS Practice Division, UCB Biosciences, Inc., Raleigh, North Carolina (e-mail: mmarko8@yahoo.com). Dr. Levitan is with Janssen Research and Development, Titusville, New Jersey. When this work was done, Ms. Mohamed was with the Division of Health Preference Assessment, RTI Health Solutions, Research Triangle Park, North Carolina. Ms. Mohamed is now with Bayer Healthcare Pharmaceuticals, Inc., Whippany, New Jersey. Dr. Johnson is with the Center for Clinical and Genetic Economics, Duke University, Durham, North Carolina. Dr. Bridges is with the Bloomberg School of Public Health, Johns Hopkins University, Baltimore. Dr. Citrome is with the Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla.

Copyright © 2014 by the American Psychiatric Association


Objective  The objectives were to quantify psychiatrists’ judgments of the benefits and risks of antipsychotic treatments of patients with schizophrenia and to evaluate how patient adherence history affects these judgments.

Methods  Weights assigned by respondents to risks, benefits, and alternative drug formulations in the treatment of schizophrenia were assessed via a Web-based survey by using a discrete-choice experiment. Respondents in the United States and the United Kingdom chose among alternative scenarios characterized by various levels of improvement in positive symptoms, negative symptoms, social functioning, weight gain, extrapyramidal symptoms (EPS), hyperprolactinemia, and hyperglycemia and by formulation. The effect of patient adherence history on respondents’ judgments was also assessed. Random-parameters logit and bivariate probit models were estimated.

Results  The sample included 394 psychiatrists. Improvement in positive symptoms from “no improvement” to “very much improved” was the most preferred outcome over the range of improvements included and was assigned a relative importance score of 10. Other outcomes, in decreasing order of importance, were improvement in negative symptoms from “no improvement” to “very much improved” (5.2; 95% confidence interval [CI]=4.2–6.2), social functioning from “severe problems” to “mild problems” (4.6, CI=3.8–5.4), no hyperglycemia (1.9, CI=1.5–2.4), <15% weight gain (1.5, CI=.9–2.0), no hyperprolactinemia (1.3, CI=.8–1.6), and no EPS (1.1, CI=.7–1.5). As adherence decreased, formulation became more important than modest efficacy changes and injections were preferred to daily pills (p<.05).

Conclusions  Psychiatrists favored treatments that primarily improve positive symptoms. Choice of formulation became more important as likely adherence declined.

Abstract Teaser
Figures in this Article

Your Session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Figure 1 Relative importance assigned to schizophrenia treatment attributes by 394 psychiatrists

a Extrapyramidal symptoms

Figure 2 Relative importance assigned by 394 psychiatrists to attributes of treatment for adherent and nonadherent patients with schizophrenia

a Extrapyramidal symptoms

b In a typical week compared with initial presentation

Anchor for Jump
Table 1Attributes and levels of improvement for the choice questions used in a survey of U.S. and U.K. psychiatrists
Table Footer Note

a Levels developed with use of the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression scale, both of which are used in clinical trials to measure improvements in schizophrenia symptoms. Although changes in PANSS positive and negative subscores are well understood by clinical trial experts, these numeric changes are likely to be less familiar to most practicing clinicians. To accommodate psychiatrists’ differing knowledge of the PANSS, these attribute definitions included textual labels (“very much improved”), PANSS subscore changes, and short examples.



Citrome  L:  New second-generation long-acting injectable antipsychotics for the treatment of schizophrenia.  Expert Review of Neurotherapeutics 13:767–783, 2013
[CrossRef] | [PubMed]
Arden  NK;  Hauber  AB;  Mohamed  AF  et al:  How do physicians weigh benefits and risks associated with treatments in patients with osteoarthritis in the United Kingdom? Journal of Rheumatology 39:1056–1063, 2012
[CrossRef] | [PubMed]
Hauber  AB;  Arden  NK;  Mohamed  AF  et al:  A discrete-choice experiment of United Kingdom patients’ willingness to risk adverse events for improved function and pain control in osteoarthritis.  Osteoarthritis and Cartilage 21:289–297, 2013
[CrossRef] | [PubMed]
Mohamed  AF;  Johnson  FR;  Hauber  AB  et al:  Physicians’ stated trade-off preferences for chronic hepatitis B treatment outcomes in Germany, France, Spain, Turkey, and Italy.  European Journal of Gastroenterology and Hepatology 24:419–426, 2012
Shumway  M;  Sentell  T;  Chouljian  T  et al:  Assessing preferences for schizophrenia outcomes: comprehension and decision strategies in three assessment methods.  Mental Health Services Research 5:121–135, 2003
[CrossRef] | [PubMed]
Bridges  JF;  Kinter  ET;  Schmeding  A  et al:  Can patients diagnosed with schizophrenia complete choice-based conjoint analysis tasks? Patient 4:267–275, 2011
[CrossRef] | [PubMed]
Bridges  JF;  Slawik  L;  Schmeding  A  et al:  A test of concordance between patient and psychiatrist valuations of multiple treatment goals for schizophrenia.  Health Expectations 16:164–176, 2013
[CrossRef] | [PubMed]
Kuhnigk  O;  Slawik  L;  Meyer  J  et al:  Valuation and attainment of treatment goals in schizophrenia: perspectives of patients, relatives, physicians, and payers.  Journal of Psychiatric Practice 18:321–328, 2012
[CrossRef] | [PubMed]
Shumway  M:  Preference weights for cost-outcome analyses of schizophrenia treatments: comparison of four stakeholder groups.  Schizophrenia Bulletin 29:257–266, 2003
[CrossRef] | [PubMed]
Shumway  M;  Chouljian  TL;  Battle  CL:  Measuring preferences for schizophrenia outcomes with the time tradeoff method.  Journal of Behavioral Health Services and Research 32:14–26, 2005
[CrossRef] | [PubMed]
Bridges  JF;  Mohamed  AF;  Finnern  HW  et al:  Patients’ preferences for treatment outcomes for advanced non-small cell lung cancer: a conjoint analysis.  Lung Cancer 77:224–231, 2012
[CrossRef] | [PubMed]
Bryan  S;  Buxton  M;  Sheldon  R  et al:  Magnetic resonance imaging for the investigation of knee injuries: an investigation of preferences.  Health Economics 7:595–603, 1998
[CrossRef] | [PubMed]
Johnson  FR;  Ozdemir  S;  Manjunath  R  et al:  Factors that affect adherence to bipolar disorder treatments: a stated-preference approach.  Medical Care 45:545–552, 2007
[CrossRef] | [PubMed]
Ryan  M;  McIntosh  E;  Shackley  P:  Methodological issues in the application of conjoint analysis in health care.  Health Economics 7:373–378, 1998
[CrossRef] | [PubMed]
Ettinger  DS;  Grunberg  SM;  Hauber  AB  et al:  Evaluation of the relative importance of chemotherapeutic and antiemetic efficacy in various oncologic settings.  Supportive Care in Cancer 17:405–411, 2009
[CrossRef] | [PubMed]
Marshall  D;  Bridges  JF;  Hauber  B  et al:  Conjoint analysis applications in health—how are studies being designed and reported? An update on current practice in the published literature between 2005 and 2008.  Patient 3:249–256, 2010
[CrossRef] | [PubMed]
Johnson FR, Yang J-C, Mohamed AF: In defense of imperfect experimental designs: statistical efficiency and measurement error in choice-format conjoint analysis. Proceedings of the Sawtooth Software Conference, Orlando, Fla, March 21–23, 2012. Available at www.sawtoothsoftware.com/support/technical-papers/conference-proceedings/proceedings2012
Louviere  J;  Swait  J;  Hensher  D:  Introduction to stated preference models and methods; in  Stated Choice Methods: Analysis and Application . Edited by Louviere  JJ;  Hensher  DA;  Swait  JD.  Cambridge, United Kingdom,  Cambridge University Press, 2000
Dodgson  JS;  Spackman  M;  Pearman  A  et al:  Multi-Criteria Analysis: A Manual .  London,  Department for Communities and Local Government, 2009
Levitan  BS;  Andrews  EB;  Gilsenan  A  et al:  Application of the BRAT framework to case studies: observations and insights.  Clinical Pharmacology and Therapeutics 89:217–224, 2011
[CrossRef] | [PubMed]
Leucht  S;  Kane  JM;  Etschel  E  et al:  Linking the PANSS, BPRS, and CGI: clinical implications.  Neuropsychopharmacology 31:2318–2325, 2006
[CrossRef] | [PubMed]
Reed Johnson  F;  Lancsar  E;  Marshall  D  et al:  Constructing experimental designs for discrete-choice experiments: report of the ISPOR conjoint analysis experimental design good research practices task force.  Value in Health 16:3–13, 2013
[CrossRef] | [PubMed]
Kuhfeld  WF:  Marketing Research Methods in SAS: Experimental Design, Choice, Conjoint, and Graphical Techniques .  Cary, NC,  SAS Institute, 2010
Kuhfeld  WF;  Tobias  RD;  Garratt  M:  Efficient experimental design with marketing research applications.  JMR 31:545–557, 1994
Bridges  JFP;  Hauber  AB;  Marshall  D  et al:  Conjoint analysis applications in health—a checklist: a report of the ISPOR Good Research Practices for Conjoint Analysis Task Force.  Value in Health 14:403–413, 2011b
[CrossRef] | [PubMed]
Mohamed  AF;  Hauber  AB;  Neary  MP:  Patient benefit-risk preferences for targeted agents in the treatment of renal cell carcinoma.  PharmacoEconomics 29:977–988, 2011
[CrossRef] | [PubMed]
Hauber  AB;  Mohamed  AF;  Johnson  FR  et al:  Treatment preferences and medication adherence of people with Type 2 diabetes using oral glucose-lowering agents.  Diabetic Medicine 26:416–424, 2009
[CrossRef] | [PubMed]
Markowitz M, Levitan B, Mohamed AF, et al: Psychiatrist and patient preferences for benefit and risk outcomes and formulation in schizophrenia treatments: comparison of two conjoint analyses. Presented at the Annual Meeting of the American Psychiatric Association, San Francisco, May 18–22, 2013
Marta-Pedroso  C;  Freitas  H;  Domingos  T:  Testing for the survey mode effect on contingent valuation data quality: a case study of web based versus in-person interviews.  Ecological Economics 62:388–398, 2007
Nielsen  JS:  Use of the internet for willingness-to-pay survey: a comparison of face-to-face and web-based interviews.  Resource and Energy Economics 33:119–129, 2011
References Container

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe

Related Content
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 20.  >
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 29.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 17.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 17.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 17.  >
Topic Collections
Psychiatric News
Read more at Psychiatric News >>
APA Guidelines
PubMed Articles