Economic Impact of Schizophrenia from a Hospital and Social Security System Perspective in Italy.
Journal
Clinical drug investigation
ISSN: 1179-1918
Titre abrégé: Clin Drug Investig
Pays: New Zealand
ID NLM: 9504817
Informations de publication
Date de publication:
Feb 2021
Feb 2021
Historique:
accepted:
28
11
2020
pubmed:
10
2
2021
medline:
23
3
2021
entrez:
9
2
2021
Statut:
ppublish
Résumé
Schizophrenia is one of the mental disorders with the highest economic and social costs, with an important burden on patients, caregivers, and society. The objective of this study was to estimate the direct and social security costs of schizophrenia in Italy. As far as direct costs are concerned, those related to hospitalizations and pharmaceutical expenditure have been analyzed, while disability benefits (DBs) and incapacity pensions (IPs) have been considered for the social security costs. In order to provide annual economic burden of schizophrenia using the real-world data, we analyzed the main regional and national databases related to hospitalizations and pharmaceuticals. Hospitalizations have been analyzed considering the Hospital Information System, which collects all the information regarding hospital discharges from all public and private hospitals (psychiatric wards or residential facilities have not been considered). Hospitalizations with a discharge date between 2009 and 2016, and with a primary or secondary diagnosis of schizophrenia (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 295.xx) were selected. Hospital costs have been estimated considering the national tariffs associated with each selected hospitalization. In addition, using the same inclusion criteria, the average DBs (for workers with reduced working capacity) and IPs (for workers without working capacity) provided each year have been analyzed from the social security benefit applications database. The estimate of pharmaceutical expenditure was prepared based on the OsMed 2018 Report (Italian Medicines Agency, latest issue 18 July 2019). A one-way deterministic sensitivity analysis was conducted to examine the robustness of the results. In Italy from 2009 to 2016, schizophrenia had an important economic impact from a social perspective. On average, 13,800 patients were hospitalized, with an average of 2.98 hospitalizations per patient. From a National Health Service (NHS) perspective and with specific reference to hospitalizations, the annual economic burden was €101.4 million, with an average cost per patient of €7338. On the other hand, pharmaceutical expenditure amounts to over €147 million each year, while residential, semi-residential, and specialist facilities amount to approximately €1 billion. Again, schizophrenia led to approximately 15,000 recipients of social security benefits (DBs and IPs) yearly from 2009 to 2015, with an average annual expenditure of €160.1 million (average cost per patient = €10,675). Our study estimates an economic burden of schizophrenia of €1250 million per year in direct costs, of which 20% is related to hospitalizations and pharmaceutical expenditure. With regard to social security benefits, an average annual expenditure of €160.1 million was calculated (average cost per patient = €10,675).
Sections du résumé
BACKGROUND
BACKGROUND
Schizophrenia is one of the mental disorders with the highest economic and social costs, with an important burden on patients, caregivers, and society.
OBJECTIVE
OBJECTIVE
The objective of this study was to estimate the direct and social security costs of schizophrenia in Italy. As far as direct costs are concerned, those related to hospitalizations and pharmaceutical expenditure have been analyzed, while disability benefits (DBs) and incapacity pensions (IPs) have been considered for the social security costs.
METHODS
METHODS
In order to provide annual economic burden of schizophrenia using the real-world data, we analyzed the main regional and national databases related to hospitalizations and pharmaceuticals. Hospitalizations have been analyzed considering the Hospital Information System, which collects all the information regarding hospital discharges from all public and private hospitals (psychiatric wards or residential facilities have not been considered). Hospitalizations with a discharge date between 2009 and 2016, and with a primary or secondary diagnosis of schizophrenia (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 295.xx) were selected. Hospital costs have been estimated considering the national tariffs associated with each selected hospitalization. In addition, using the same inclusion criteria, the average DBs (for workers with reduced working capacity) and IPs (for workers without working capacity) provided each year have been analyzed from the social security benefit applications database. The estimate of pharmaceutical expenditure was prepared based on the OsMed 2018 Report (Italian Medicines Agency, latest issue 18 July 2019). A one-way deterministic sensitivity analysis was conducted to examine the robustness of the results.
RESULTS
RESULTS
In Italy from 2009 to 2016, schizophrenia had an important economic impact from a social perspective. On average, 13,800 patients were hospitalized, with an average of 2.98 hospitalizations per patient. From a National Health Service (NHS) perspective and with specific reference to hospitalizations, the annual economic burden was €101.4 million, with an average cost per patient of €7338. On the other hand, pharmaceutical expenditure amounts to over €147 million each year, while residential, semi-residential, and specialist facilities amount to approximately €1 billion. Again, schizophrenia led to approximately 15,000 recipients of social security benefits (DBs and IPs) yearly from 2009 to 2015, with an average annual expenditure of €160.1 million (average cost per patient = €10,675).
CONCLUSIONS
CONCLUSIONS
Our study estimates an economic burden of schizophrenia of €1250 million per year in direct costs, of which 20% is related to hospitalizations and pharmaceutical expenditure. With regard to social security benefits, an average annual expenditure of €160.1 million was calculated (average cost per patient = €10,675).
Identifiants
pubmed: 33559103
doi: 10.1007/s40261-020-00991-7
pii: 10.1007/s40261-020-00991-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
183-191Références
Gustavsson A, Svensson M, Jacobi F, et al. Cost of disorders of the brain in Europe 2010. Eur Neuropsychopharmacol. 2011;21:718–79.
doi: 10.1016/j.euroneuro.2011.08.008
Tansella M, De Girolamo G. The spread of mental disorders in the community. Rome: Department of Medicine and Public Health, Psychiatric Section, University of Verona; National Project of Mental Health, Laboratory of Epidemiology, Health Institute; 2005. http://www.cittadinanzaesalute.org/wp-content/uploads/2016/09/Diffusione-Disturbi-Mentali_Italia.pdf . Accessed 13 Jan 2021.
Saha S, Chant D, Welham J, et al. A systematic review of the prevalence of schizophrenia. PLoS Med. 2005;2:e141.
doi: 10.1371/journal.pmed.0020141
Altamura C, Galderisi P, Rocca A, et al. Schizophrenia today: epidemiology, diagnosis, course and models of care. Ital J Psychopathol. 2014;20:223–43.
Altamura AC, Serati M, Albano A, et al. An epidemiologic and clinical overview of medical and psychopathological comorbidities in major psychoses. Eur Arch Psychiatry Clin Neurosci. 2011;261:489–508.
doi: 10.1007/s00406-011-0196-4
Knapp M, Mangalore R, Simon J. The global costs of schizophrenia. Schizophr Bull. 2004;30:279–93.
doi: 10.1093/oxfordjournals.schbul.a007078
Rocca P, Giugiaro M, Bogetto F. Compliance in the treatment of schizophrenia. Riv di Psichiatria. 2006;41(5):301–6.
Garattini L, Barbui C, Clemente R, et al. Direct costs of schizophrenia and related disorders in Italian community mental health services: a multicenter, prospective 1-year followup study. Schizophr Bull. 2004;30:295–302.
doi: 10.1093/oxfordjournals.schbul.a007079
Garattini L, Rossi C, Tediosi F, et al. Direct costs of schizophrenia in Italian community psychiatric services. Pharmacoeconomics. 2001;19:1217–25.
doi: 10.2165/00019053-200119120-00004
Cortesi PA, Mencacci C, Luigi F, et al. Compliance, persistence, costs and quality of life in young patients treated with antipsychotic drugs: results from the COMETA study. BMC Psychiatry. 2013;13:98.
doi: 10.1186/1471-244X-13-98
Niolu C, Barone Y, Bianciardi E, et al. Predictors of poor adherence to treatment in inpatients with bipolar and psychotic spectrum disorders. Riv Psichiatr. 2015;50:285–94.
pubmed: 26780202
Niolu C, Bianciardi E, Di Lorenzo G, et al. Enhancing adherence, subjective well-being and quality of life in patients with schizophrenia: which role for long-acting risperidone? Ther Adv Psychopharmacol. 2015;5:278–88.
doi: 10.1177/2045125315596897
Ministerial Decrees of 12th September 2006. Reconnaissance and first update of the maximum tariffs for the remuneration of healthcare services. 2006. https://www.gazzettaufficiale.it/atto/serie_generale/caricaDettaglioAtto/originario?atto.dataPubblicazioneGazzetta=2006-12-13&atto.codiceRedazionale=06A11377&elenco30giorni=false . Accessed 13 Jan 2021.
Ministerial Decrees of 18th October 2012. Remuneration for acute hospital care, hospital rehabilitation and post-acute long-term care and specialist outpatient care. 2012. https://www.gazzettaufficiale.it/eli/id/2013/01/28/13A00528/sg . Accessed 13 Jan 2021
OsMed 2018 Report. The use of drugs in Italy (AIFA, latest issue 18/07/2019). 2019. https://www.aifa.gov.it/web/guest/-/rapporto-osmed-20-1 . Accessed 13 Jan 2021.
INPS, Databases and financial statements. Statistics Observatories. 2020. https://www.inps.it/nuovoportaleinps/default.aspx?sPathID=%3b0%3b46437%3b46458%3b46473%3b&lastMenu=46473&iMenu=12&iNodo=46473&p4=2 . Accessed 13 Jan 2021.
Law 222/84, Legislative Decree 503/92. 2020. https://www.gazzettaufficiale.it/eli/id/1984/06/16/084U0222/sg . Accessed 13 Jan 2021.
Russo S, Mariani TT, Migliorini R, Marcellusi A, Mennini FS. The economic burden of musculoskeletal disorders on the Italian social security pension system estimated by a Monte Carlo simulation. Reumatismo. 2015;67(2):45–56.
doi: 10.4081/reumatismo.2015.811
Marcellusi A, Rotundo MA, Nardone C, et al. Osteoporosis: Economic Burden of Disease in Italy. Clin Drug Investig. 2020;2020(40):449–58. https://doi.org/10.1007/s40261-020-00904-8 .
doi: 10.1007/s40261-020-00904-8
National Institute of Statistics. Pensions and recipients. Year 2014, 2015. 2020. https://www.istat.it/it/files//2015/12/Trattamenti-pensionistici-e-beneficiari_2014.pdf . Accessed 13 Jan 2021.
Marcellusi A, Fabiano G, Viti R, et al. Economic burden of schizophrenia in Italy: a probabilistic cost of illness analysis. BMJ Open. 2018;8(2):e018359.
doi: 10.1136/bmjopen-2017-018359