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.
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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...