Open Access Research article

Compliance, persistence, costs and quality of life in young patients treated with antipsychotic drugs: results from the COMETA study

Paolo A Cortesi12, Claudio Mencacci3, Ferrannini Luigi4, Elvezio Pirfo5, Patrizia Berto6, Miriam CJM Sturkenboom7, Fabiana L Lopes8, Maria G Giustra8, Lorenzo G Mantovani29* and Luciana Scalone12

Author Affiliations

1 Research Centre on Public Health (CeSP), Univeristy of Milan - Bicocca, Monza, Italy

2 CHARTA Foundation, Milan, Italy

3 Mental Health Department, Fatebenefratelli Hospital, Milan, Italy

4 Departement of Mental Health, ASL 3 Genovese, Genoa, Italy

5 Mental Health Department G. Maccacaro, Turin, Italy

6 PBE consulting, Verona, and School of Pharmacy, University of Padua, Padua, Italy

7 Department of Epidemiology & Biostatistics and Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands

8 Medical Affairs, Janssen-Cilag SpA, Cologno Monzese, Milan, Italy

9 Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy

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BMC Psychiatry 2013, 13:98  doi:10.1186/1471-244X-13-98

Published: 22 March 2013



Little data is available on the real-world socio-economic burden and outcomes in schizophrenia. This study aimed to assess persistence, compliance, costs and Health-Related Quality-of-Life (HRQoL) in young patients undergoing antipsychotic treatment according to clinical practice.


A naturalistic, longitudinal, multicentre cohort study was conducted: we involved 637 patients aged 18–40 years, with schizophrenia or schizophreniform disorder diagnosed ≤10 years before, enrolled in 86 Italian Mental Health Centres and followed-up for 1 year. Comparisons were conducted between naïve (i.e., patients visiting the centre for the first time and starting a new treatment regimen) and non naïve patients.


At enrolment, 84% of patients were taking atypical drugs, 3.7% typical, 10% a combination of the two classes, and 2% were untreated. During follow-up, 23% of patients switched at least once to a different class of treatment, a combination or no treatment. The mean Drug-Attitude-Inventory score was 43.4, with 94.3% of the patients considered compliant by the clinicians. On average, medical costs at baseline were 390.93€/patient-month, mostly for drug treatment (29.5%), psychotherapy (29.2%), and hospitalizations (27.1%). Patients and caregivers lost 3.5 days/patient-month of productivity. During follow-up, attitude toward treatment remained fairly similar, medical costs were generally stable, while productivity, clinical statusand HRQoL significantly improved. While no significantly different overall direct costs trends were found between naïve and non naïve patients, naïve patients showed generally a significant mean higher improvement of clinical outcomes, HRQoL and indirect costs, compared to the others.


Our results suggest how tailoring the treatment strategy according to the complex and specific patient needs make it possible to achieve benefits and to allocate more efficiently resources. This study can also provide information on the most relevant items to be considered when conducting cost-effectiveness studies comparing specific alternatives for the treatment of target patients.

Schizophrenia; Medication compliance; Persistence; Cost of illness; Quality of life