Direct medical costs associated with schizophrenia relapses in health care services in the city of São Paulo

Abstract

OBJECTIVE:To assess direct medical costs associated with schizophrenia relapses in mental health services. METHODS:The study was conducted in three health facilities in the city of São Paulo: a public state hospital; a Brazilian National Health System (SUS)-contracted hospital; and a community mental health center. Medical records of 90 patients with schizophrenia who received care in 2006 were reviewed. Information on inpatient expenditures was collected and used for cost estimates. RESULTS:Mean direct medical cost of schizophrenia relapses per patient was US$ 4,083.50 (R$ 8,167.58) in the public state hospital; US$ 2,302.76 (R$ 4,605.46) in the community mental health center; and US$ 1,198.50 (R$ 2,397.74) in the SUS-affi liated hospital. The main component was daily inpatient room rates (87% -98%). Medication costs varied depending on the use of typical or atypical antipsychotic drugs. Atypical antipsychotic drugs were more often used in the community mental health center. CONCLUSIONS:Costs associated with schizophrenia relapses support investments in antipsychotic drugs and strategies to reduce disease relapse and the need for mental health inpatient services. Treating patients in a community mental health center was associated with medium costs and added the benefi t of not depriving these patients from family life. The mean incidence of schizophrenia is one to two cases per 10,000 people per year and its prevalence is 0.7% in adults worldwide. 17 In Brazil, the literature shows inconsistent data, but schizophrenia prevalence is likely higher than that reported, and close to that reported in a meta-analysis by McGrath et al. 18,23 Schizophrenia has a chronic course with an estimated improvement of 40% after fi ve to six years of follow-up. DESCRIPTORS: 7To assess schizophrenia burden, reviewed 62 studies and found three major studies on costs associated to schizophrenia from the United States, Canada, and England. 10 The US study estimated a total cost of US$ 62.7 billion in 2002, of which US$ 22.7 billion in direct costs; US$ 7.6 billion in non-medical direct costs and US$ 32.4 billion in indirect costs. 27The Canadian study estimated a cost of schizophrenia of C$ 6.5 billion in 2004, of which C$ 2.02 billion in direct medical and non-medical costs and C$ 4.83 billion in indirect costs. 5 The English study estimated total schizophrenia-related costs in 2004 and 2005 were £ 6.7 billion, £ 2 billion in direct and £ 4.7 billion in indirect costs.14 In all three studies the main component of indirect cost was loss of productivity. According to the Global Burden of Disease Assessment, schizophrenia causes a high degree of disability and accounts for 1.1% of all disability-adjusted life years (DALYs), and for 2.8% of all years lived with disability (YLDs). CONCLUSÕES:O investimento em medicações antipsicóticas e em estratégias que diminuam a recaída e a necessidade de diárias nos serviços, especialmente hospitalares, são justifi cáveis pela proporção dos custos que estas representam. Tratar a recaí...

Análisis de costos de atención médica para esquizofrenia y depresión en México para el periodo 2005-2013

“…Para el caso de otros países de América Latina, el costo de tratamiento hospitalario de una recaída de paciente con esquizofrenia en un hospital público de Brasil se reportó en USD 2.302,00, 80-90% debidos al costo de la estancia y el resto a medicación. Sin embargo, no se incluyen costos como limpieza y alimentación 31 . En Colombia se evaluaron costos directos de hospitalización para depresión em USD 705,00 y el costo promedio de tratamiento diario es de USD 62,00, considerando casos de depresión severa y moderada que requieren manejo intrahospitalario 32 .…”

Economic evaluation in the field of mental health: conceptual basis

“…Pharmacological interventions were the most common technology to be assessed, mainly in schizophrenia, alcohol/substance disorder, and major depressive disorders. [36][37][38][39][40] This scarcity shows the need for development of the mental health economics field in Brazil, mainly regarding human resources, to conduct methodologically adequate research.…”

REVIEW ARTICLE Mental health economics: Insights from Brazil

“…However, only five studies could be classified as economic evaluations. Of these studies, most were on schizophrenia (Leitão et al, 2006;Lindner et al, 2009;Daltio et al, 2011), one on alcohol addiction (Moraes et al, 2010) and one on the major depressive disorders (Machado et al, 2007). Two studies performed cost analyses (Leitão et al, 2006;Lindner et al, 2009) and three were full economic analyses (Daltio et al, 2011;Machado et al, 2007;Moraes et al, 2010).…”

“…Most CE studies used secondary data collected from international literature. Pharmacological interventions were the most common technology assessed (Leitão et al, 2006;Lindner et al, 2009;Daltio et al, 2011;Machado et al, 2007). One evaluation of health services and programs was also found (Moraes et al, 2010).…”

“…One evaluation of health services and programs was also found (Moraes et al, 2010). In general, costs were evaluated under the perspective of the public healthcare system and prices were assessed as if they were purchased by the government for all studies (Leitão et al, 2006;Lindner et al, 2009;Daltio et al, 2011;Machado et al, 2007;Moraes et al, 2010).…”