The paper is a fragment of the studies into estimation of expenditures in a representative group (386 patients) with schizophrenia. The authors describe the results of an analysis of "direct" and "indirect" expenditures incurred for the treatment of schizophrenic patients depending on the sex, age, disease pattern, prevailing positive syndrome, and the level of negative symptomatology. The values of these expenditures turned out fairly variable. It could be demonstrated that there are definite, significant correlations between the magnitude of these expenditures and ++clinico-psychopathological factors. The highest expenditures were recorded in patients fit for work, they are largely determined by expenditures for inpatient treatment and disability payments. It should be emphasized that in male patients, they appear much higher, particularly in the group of patients with simple schizophrenia. It means that using economic estimates indirectly reflecting the gravity and characteristic features of schizophrenia, one can assess different manifestations of the disease in terms of universal units of cost.
The paper is concerned with part of the results of an analysis of expenditures for the treatment of schizophrenic patients. The task of the present fragment was to delineate ways of optimizing the functioning of the psychiatric assistance services. Research methods including clinico-economic, statistic, mathematic and epidemiological approaches are described in detail. Based on an examination of the representative group of schizophrenic patients (n-386) of one of the psychoneurological dispensaries of Moscow, it has been established that the main "direct" (793.8 rubels per patient/year on the average) and "indirect" (3520.94 rubels per patient/year on the average) expenditures are connected with expensive inpatient treatment and disability allowance payments. It is suggested that redistribution of investments with a purpose of eliminating economic unbalance between different psychiatric services (hospital and ambulatory) will contribute to optimizing their functioning and enable the efficacy of their work to be enhanced.
Information about the cost-effectiveness of early intervention programmes for first-episode psychosis is limited.
To evaluate the cost-effectiveness of an intensive early-intervention programme (called OPUS) (trial registration NCT00157313) consisting of enriched assertive community treatment, psychoeducational family treatment and social skills training for individuals with first-episode psychosis compared with standard treatment.
An incremental cost-effectiveness analysis of a randomised controlled trial, adopting a public sector perspective was undertaken.
The mean total costs of OPUS over 5 years (€123,683, s.e. = 8970) were not significantly different from that of standard treatment (€148,751, s.e. = 13073). At 2-year follow-up the mean Global Assessment of Functioning (GAF) score in the OPUS group (55.16, s.d. = 15.15) was significantly higher than in standard treatment group (51.13, s.d. = 15.92). However, the mean GAF did not differ significantly between the groups at 5-year follow-up (55.35 (s.d. = 18.28) and 54.16 (s.d. = 18.41), respectively). Cost-effectiveness planes based on non-parametric bootstrapping showed that OPUS was less costly and more effective in 70% of the replications. For a willingness-to-pay up to €50,000 the probability that OPUS was cost-effective was more than 80%.
The incremental cost-effectiveness analysis showed that there was a high probability of OPUS being cost-effective compared with standard treatment.
Estimates of the direct costs of mental health services for patients with schizophrenia are made from a registration of all patients seen during a period of 4 weeks in all treatment units serving 6 catchment areas. The estimates were based on unit costs. The total direct costs of mental health services for schizophrenic patients in Norway were estimated to be NOK 1158 million (US$ 164 million). In total, 74.3% of the costs are for long-term in-patient care, 19.7% are for acute and intermediate length in-patient care, and 6.0% are for out-patient and day care. The average costs of schizophrenic patients with a GAF score of 1-20 are almost twice those of patients with a GAF score of 21-40, and more than three times those of patients with a GAF score of 41-60.
Mental health policies, advocating outpatient as well as community mental health care for the severely mentally ill, are aiming towards health system cost containment and patient quality of life. Programs with cognitive behavioral therapy, such as the Integrated Psychological Therapy (IPT), added to standard medical therapy for patients with schizophrenia have been associated with improved outcomes. A Quebec version of the IPT program was integrated in outpatient clinics and improvements were observed in overall symptoms, subjective experiences, cognitive and social functioning, and quality of life. In light of these results we deemed it relevant to describe the health system cost and patient resource use associated with the program. The costs related to IPT have not been previously reported and this study will elucidate on effective health services and budget allocation needed to include IPT.
To describe health care resource use and related costs associated with participating in an IPT program included as standard medical therapy in nine clinical settings.
A cohort of patients with schizophrenia participating in the IPT program were followed up to one year preceding the start of the program and concurrently until the end to compare the resource use and costs incurred by patients with schizophrenia during their participation. A health and social service system and patient perspective was adopted, and the medical and non-medical costs associated with the IPT program were measured. Valuation (2001 CDN dollars) was based on information provided by provincial billing systems. Statistical differences were assessed using the Wilcoxon signed-rank test.
The IPT program induced a one time fixed cost (2347 dollars) for the training of mental health professionals and costs related to patient participation (1350 dollars). Our results show that there was an average decrease in health care system resource use per patient during the IPT program (26,133 dollars) as opposed to the preceding year (26,750 dollars). There was a significant decrease in the number of visits and in physician fees paid out to psychiatrists, the number of hospitalizations and related costs, and visits to the emergency department per patient during the IPT program as compared to the preceding year. No significant difference was observed in patient related costs which averaged 7295 dollars and 7537 dollars, before and during the IPT program, respectively.
Although the IPT program induces a one time fixed cost for training, the integration of IPT, as part of an individualized standard medical therapy, is associated with a change from inpatient towards outpatient resource use with no significant increase in health system related costs.
Given clinical and quality of life improvements, the findings suggest that offering IPT to more patients with severe mental illness may prove more cost beneficial by decreasing the health system related costs per user in the long term.
Additional research is needed to examine in parallel the long-term clinical and cost impact of the IPT program in different clinical settings (young adults to long term mentally ill). This will elucidate to which patient population IPT is most cost-effective.
Since 1992 the Danish Patient Insurance Association (DPIA) has been receiving claims from patients who had suffered an injury during examination or treatment in Danish healthcare. We have presently collected more than 85,000 patient cases in our database, which we make accessible to research that can promote patient safety. We now want to draw attention to conditions that mainly apply to patients with mental disorders.
By searching the DPIA database over the past 15 years, we identified 1,278 patients with mental disorders. These patients were studied with respect to whether they had been treated within the psychiatric specialty or in a somatic specialty. During the study period, there was a change of opinion in the legal system after the Supreme Court ruled that surveillance of a psychiatric patient during admission, e.g. as anti-suicide precaution, should also be considered part of the treatment.
Of the registered claims, 742 had received specialised psychiatric treatment for their mental disorders, and 536 had been treated in one of the somatic specialties. Of the 1,278 patients, 16% had their claims accepted. A marked difference was found in the acceptance rate of claims between these two groups: in psychiatry, 13% of the claims were accepted, whereas in the somatic specialties, the acceptance rate was 21%. Both of these numbers are well below the usual DPIA acceptance rate, which is 36% (p = 0.001). During the study period, there was a change in the Danish legal system after the Danish Supreme Court ruled that surveillance of a psychiatric patient during admission, e.g. as an anti-suicide precaution, should be considered part of the treatment.
The low acceptance rate for claims made by patients with mental disorders concerning treatment or examination may, in part, be due to the lodging of unqualified claims, but other causes may also have contributed to this. Psychiatric patients who are treated for somatic disease should receive special attention to avoid treatment-related injuries.