Physical health examination in outpatients with schizophrenia: the cost effectiveness of laboratory screening tests
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(2020) 19:70 Eskelinen et al. Ann Gen Psychiatry https://doi.org/10.1186/s12991-020-00321-3
Open Access
PRIMARY RESEARCH
Physical health examination in outpatients with schizophrenia: the cost effectiveness of laboratory screening tests Saana Eskelinen1,2* , Janne V. J. Suvisaari3 and Jaana M. Suvisaari2
Abstract Background: Guidelines on laboratory screening in schizophrenia recommend annual monitoring of fasting lipids and glucose. The utility and the cost effectiveness of more extensive laboratory screening have not been studied. Methods: The Living Conditions and the Physical Health of Outpatients with Schizophrenia Study provided a comprehensive health examination, including a laboratory test panel for 275 participants. We calculated the prevalence of the results outside the reference range for each laboratory test, and estimated the cost effectiveness to find an aberrant test result using the number needed to screen to find one abnormal result (NNSAR) and the direct cost spent to find one abnormal result (DCSAR, NNSAR x direct cost per test) formulas. In addition, we studied whether patients who were obese or used clozapine had more often abnormal results. Results: A half of the sample had 25-hydroxyvitamin D below, and almost one-fourth cholesterol, triglycerides or glucose above the reference range. One-fifth had sodium below and gamma glutamyltransferase above the reference range. NNSAR was highest for potassium (137) and lowest for 25-hydroxyvitamin D (2). DCSAR was below 5€ for glucose, all lipids and sodium, and below 10€ for creatinine and gamma glutamyltransferase. Potassium (130€), pHadjusted ionized calcium (33 €) and thyroid stimulating hormone (33€) had highest DCSARs. Several abnormal results were more common in obese and clozapine using patients. Conclusions: An annual laboratory screening panel for an outpatient with schizophrenia should include fasting glucose, lipids, sodium, creatinine, a liver function test and complete blood count, and preferably 25-hydroxyvitamin D. Keywords: Schizophrenia, Physical, Somatic, Screening, Laboratory Background Health care workers providing services for people with schizophrenia and other severe mental disorders are advised to pay close attention to the physical well-being of their patients [1]. Patients with schizophrenia are prone to a variety of physical illnesses and risk factors, and have a shortened life-expectancy [2–4]. Especially cardiovascular diseases and metabolic disturbances, such *Correspondence: [email protected] 1 Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 590, 00029 Helsinki, Finland Full list of author information is available at the end of the article
as metabolic syndrome, type 2 diabetes and obesity, are substantially more common than in the general population [5–8]. Guidelines on laboratory monitoring in schizophrenia usually recommend fasting lipids and glucose testing annually after the first year of antipsychotic medication use [9]. The aim of the testing is to reveal increased car
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