Health care resource use and direct medical costs for patients with schizophrenia in Tianjin, People’s Republic of China

Abstract

ObjectiveInformation concerning the treatment costs of schizophrenia is scarce in People’s Republic of China. The aims of this study were to quantify health care resource utilization and to estimate the direct medical costs for patients with schizophrenia in Tianjin, People’s Republic of China.MethodsData were obtained from the Tianjin Urban Employee Basic Medical Insurance (UEBMI) database. Adult patients with ≥1 diagnosis of schizophrenia and 12-month continuous enrollment after the first schizophrenia diagnosis between 2008 and 2009 were included. Both schizophrenia-related, psychiatric-related, and all-cause related resource utilization and direct medical costs were estimated.ResultsA total of 2,125 patients were included with a mean age of 52.3 years, and 50.7% of the patients were female. The annual mean all-cause costs were $2,863 per patient with psychiatric-related and schizophrenia-related costs accounting for 84.1% and 62.0% respectively. The schizophrenia-related costs for hospitalized patients were eleven times greater than that of patients who were not hospitalized. For schizophrenia-related health services, 60.8% of patients experienced at least one hospitalization with a mean (median) length of stay of 112.1 (71) days and a mean cost of $1,904 per admission; 59.0% of patients experienced at least one outpatient visit with a mean (median) number of visits of 6.2 (4) and a mean cost of $42 per visit during the 12-month follow-up period. Non-medication treatment costs were the most important element (45.7%) of schizophrenia-related costs, followed by laboratory and diagnostic costs (19.9%), medication costs (15.4%), and bed fees (13.3%).ConclusionThe costs related to the treatment of patients with schizophrenia were considerable in Tianjin, People’s Republic of China, driven mainly by schizophrenia-related hospitalizations. Efforts focusing on community-based treatment programs and appropriate choice of drug treatment have the potential to reduce the use of inpatient services and may lead to better clinical and economic outcomes in the management of patients with schizophrenia in People’s Republic of China.

The Cost of Relapse in Schizophrenia

“…Sixteen papers reported costs of relapse over a defined period of observation (table 1). The studies originated from US (5) [10,[15][16][17][18], UK (1) [19], Germany (2) [20,21], Brazil (1) [22], Singapore (1) [23], China (2) [24,25], Australia (1) [26], and Sweden (1) [27], with the remaining two pan-European [28,29]. All were based on retrospective analysis of clinical or administrative data and used a bottom-up costing approach.…”

“…Thirteen studies allowed calculation of an excess cost of relapse from comparison of data on relapsing and non-relapsing patients [10,[15][16][17][18][19][20][23][24][25][26][27][28] and one paper reported the proportional cost increase associated with relapse without reporting the raw costs [21]. The majority of studies reported costs over one year [10,16,17,20,[22][23][24][25][26]28]; one study reported costs over 15 months [18]; three studies reported costs over 6 months [19,21,27]; one study reported costs over three months [29] and one study reported costs over one week [15]. The majority of studies reported mental health related costs [10,18,19,[21][22][23][25][26][27]29].…”

“…The majority of studies reported costs over one year [10,16,17,20,[22][23][24][25][26]28]; one study reported costs over 15 months [18]; three studies reported costs over 6 months [19,21,27]; one study reported costs over three months [29] and one study reported costs over one week [15]. The majority of studies reported mental health related costs [10,18,19,[21][22][23][25][26][27]29]. Six studies reported all cause health costs [15][16][17]20,24,25], of which three also reported schizophrenia related costs [15,16,20], one study also reported total costs [24], and one study reported all-cause, mental health related and schizophrenia related costs [25].…”

“…The majority of studies reported mental health related costs [10,18,19,[21][22][23][25][26][27]29]. Six studies reported all cause health costs [15][16][17]20,24,25], of which three also reported schizophrenia related costs [15,16,20], one study also reported total costs [24], and one study reported all-cause, mental health related and schizophrenia related costs [25]. One study reported solely schizophrenia related costs [28].…”

“…Forty-three studies either reported a cost per hospitalisation for relapse or provided sufficient data to calculate a mean cost (table 2) [16,25,27,28,. Four of these studies provided data on the cost of hospitalisation in addition to the cost of relapse over a defined period and are included in both tables 1 and 2 [16,25,27,28].…”