Introduction. Schizophrenia is severe mental disease. Chronic in course and usually lifelong schizophrenia is a major health care burden due to the diversity of resources needed to manage the disorder and indirect costs to society. Antipsychotic medications, have improved outcomes, but success remains limited due to high rates of patient non-adherence. Traditional clinical effectiveness studies are failing to differentiate treatments and to capture patients' perspectives.

Objective. To identify the attributes associated with medical treatment of schizophrenia; determine if patients with schizophrenia have preferences for treatment outcomes (Chapters 3 and 4); and assess the relative value and willingness to trade across outcomes from the patient's perspective (Chapter 5).

Methods. Study eligibility criteria included ICD-10 diagnosis of schizophrenia, undergoing treatment with an antipsychotic medication for at least 1 year, stable at the time of participation and living in Germany. Focus groups were conducted to identify outcomes related to treatment from the patient's perspective and were triangulated through a literature review and physician interviews, followed by in-depth individual interviews to assess patient understanding and to determine if patients have preferences for different outcomes using a ranking exercise (Chapter 4). A conjoint analysis survey was developed and implemented to assess patient valuation associated with different treatment outcomes through estimated part-worth utilities and compared clinical to nontraditional outcome evaluation (Chapter 5).

Results. Published literature suggests that incorporation of patient-relevant outcomes in evaluations better represents patient health status (Chapter 3). Focus group results showed that patient and physician treatment priorities were not always the same. In-depth interviews showed that patient's with schizophrenia do have distinct preferences for treatment outcomes and place higher value on patient-relevant outcomes and the patient-physician relationship than traditional clinical outcome measures (Chapter 4). Patients valued non-traditional outcomes, daily activities (OR 3.22, p<0.001) over the clinical outcomes, minimization of disease symptoms (OR=1.46, p<0.01) and avoiding a relapse (OR=1.31, p<0.04), as well as having a supportive physician (OR=2.34, p<0.001) (Chapter 5).

Conclusions. Patients with schizophrenia have valid preferences for treatment outcomes. Traditional clinical outcome measures in evaluating treatments with schizophrenia do not adequately capture a patient's health state and preferences. Conjoint analysis is a feasible method for health state valuation among schizophrenia patients.