The effect of previous psychiatric history on the cost of care: a comparison of various regression models

Abstract

The regression models allow us to predict cost for a patient with a given set of characteristics. Great care in the interpretation of the values of the individual coefficients should be taken in order to have a broader understanding of the expenditure dynamic.

The difficult task of predicting the costs of community-based mental health care. A comprehensive case register study

“…The patients were divided into four groups on the basis of their previous service utilisation. This classification was chosen on the basis of the previous studies conducted in the same catchment area Mirandola et al 2004) to consider the different frequency and type of contacts and continuity of care among patients who were first ever or with an ongoing episode or reopening a new or an old episode of care. Higher costs resulted for patients with an ongoing episode, which one can relate to the profile of these patients, who were likely to have a more severe diagnosis, to be single, a resident in a psychiatric residential facility or sheltered accommodation and unemployed.…”

“…The patients were divided into four groups on the basis of their previous service utilisation, using the same criteria as Mirandola et al (2004): (a) first-ever patients (patients at their first lifetime contact with a mental health service); (b) patients with an ongoing episode of care (patients with previous psychiatric history and with a contact within a 90-day period before the index contact); (c) patients having a new episode, after an interval with no contacts between 3 months and 3 years after the latest contact (91-1095 days); (d) patients having a new episode, after an interval longer than 3 years (1096 days and more). These criteria were chosen on clinical grounds and according to previous PCR studies in which an episode of care is considered closed or interrupted when a gap of more than 90 days without psychiatric contact occurred .…”

“…A previous case register study conducted in South Verona, Italy, found that previous psychiatric history was the best predictor of future costs of care (Mirandola et al 2004). First-ever patients and patients with a new episode of care after 3 years of no contact were less costly than patients with an ongoing episode and patients having a new episode after less than 3 years of no contact.…”

Predicting costs of mental health care: a critical literature review

“…Predictive studies, however, aim to estimate or predict psychiatric service utilization and costs for future users of mental health services, for whom empirical cost data remain unknown. This is the third 'predictive ' approach described by Mirandola et al (2004).…”

“…As commented by Knapp (1999) : 'more and more stakeholders in mental health care systems want economic evidence to guide their arguments, decisions and behaviours ' (p. 165). Mirandola et al (2004) outline three main types of research approaches in health cost evaluation : (i) studies that describe costs in different groups of patients (descriptive approach) ; (ii) studies that attempt to explain the variations in costs between patient groups, taking into account different clinical, social and service history variables (explanatory approach) ; and (iii) studies that aim to predict the costs of future patients, either individually or collectively (predictive approach). Most studies published to date in this field fall into the first two categories.…”