A comparison of two different services treating schizophrenia: a cost–benefit approach

Abstract

SYNOPSISThis study compares the clinical and social outcome for 2 cohorts of patients who had a first admission for schizophrenia 4 years earlier. One cohort was treated in a psychiatric unit attached to a teaching district general hospital (DGH(T)), while the other was treated at an area mental hospital (AMH) with modern rehabilitation facilities. The clinical outcome for the 2 cohorts was broadly similar, but the DGH(T) imposed less of a strain on relatives, and was associated with less unmet need. The DGH unit tended to have significantly shorter durations of stay for its patients, so that its total hospital costs were less than those for the AMH despite higher unit costs. The cost benefit analysis shows that, where these particular patients are concerned, the DGH(T) unit is economically superior to the AMH despite the fact that it supports a large teaching staff, and that these economic advantages are accompanied by various non-monetary advantages.

Economic Evaluation of Mental Health Care Interventions. A Review

“…Especially in mental health care, psychosocial costs such as grief and loss of well-being play a major role. Seven studies 1,68,72,78,118,130,145 mentioned these costs as being relevant and tried to fit them into the analysis.…”

“…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.…”

“…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. 99,111 If data are not available from any of these sources, one can estimate the cost.…”

“…67,71,80,93,109,139,156 Valuation of costs: Only a few studies calculated the actual cost prices. 68,125,136 As is common in economic evaluation studies, charges were used as a proxy for the costs in many studies. 58-61, 70, 73, 74, 84, 86, 87,91, 98, 102, 106, 107, 111, 113, 116,128,135,138,140,142,150 Charges are not costs but rather 'negotiated prices'.…”