Cost Evaluation of Chronic Schizophrenic Patients During the First 3 Years After the First Contact

Abstract

This study was performed in Italy, where mental health care is largely provided by the Government-financed Italian National Health Service (INHS). Since 1978, outpatient services and psychiatric beds in general hospitals have replaced psychiatric hospitals, which have not been permitted to admit new patients. The direct costs of three cohorts of 20 chronic schizophrenic patients were evaluated according to incidence data for a 3-year period. The analysis focused in particular on services provided by public institutions. The average cost per patient during this period following first contact-admission was $9,612 (1989 U.S. dollars), which is low compared to costs in other countries. The cost distribution between inpatient and outpatient services was different from other studies and showed that, in Italy, hospital expenses covered approximately 50 percent of total direct INHS costs. The length of time between onset and first contact-admission showed a significant association (p less than 0.01) with INHS costs during the 3 years. A significant association (p less than 0.05) also was found between the Scale for the Assessment of Positive Symptoms (SAPS) global symptom "delusions" evaluated after 5 to 7 years and the average INHS costs during the 3 years of the study.

Economic Evaluation of Mental Health Care Interventions. A Review

“…95 The studies reviewed evaluated a wide range of different kinds of alternatives, including diagnostic procedures, 96-99 public policies, [100][101][102] preventive programmes 71 and rehabilitation programmes. 80,103 However two-thirds of the studies (62 studies) referred to a choice of therapies.…”

“…One can use records available through health service suppliers. 3,56,57,68,69,76,79,102,108,110,116,121,122,127,130,[144][145][146][147] In addition, caseregisters or other macro-level records (e.g. Medicaid records, California County Public Mental Health Information System) can be employed to glean information from several institutions.…”

“…If one wants to get a full picture of the costs and especially if one wants to include the out-ofpocket expenses and indirect cost, one can interview the patient and/or the patient's family [51][52][53]56,57,64,65,68,70,102,107,113,121,125,127,135,138,145 or send a questionnaire to them. 68,118,130 A number of researchers supplemented the cost data which they had obtained themselves by adapting data from other studies 74,86,93,97,131,134,141,[152][153][154] or by making a model to discover how large the costs are.…”

“…95 Discounting is not relevant if the study period is less than 1 year. 73,75,77,79,92,114,[119][120][121]123,[131][132][133]147,150,151,156 In our review, 22 studies 54,55,[58][59][60][61]66,[69][70][71]74,78,88,90,93,98,102,113,118,130,[134][135][136]141,145 discounted or indexed the results to a certain year, with discount rates usually varying between 2.5 and 6%. The most frequently used rates were 5 and 6%.…”

Fact versus fantasy: A reply to Bentall & Morrison

“…Unfortunately, the belief is based on a naı¨ve misinterpretation of the available data. These data show that the duration of untreated psychosis (DUP) is associated with increased risk of relapse , psychosocial decline (Jones et al, 1993), prolonged morbidity (Wyatt et al, 1997), increased treatment costs (Moscarelli et al, 1991), worse course and outcome (Haas, 1990;Helgason et al, 1998), and increased duration of the acute episode (Loebel et al, 1992;McGorry et al, 1996). Along with other early intervention advocates, Bentall and Morrison assume that this association is a direct effect of prolonged psychosis, but there is a simpler explanation.…”