RESUMEN
BACKGROUND: Despite its relatively low lifetime prevalence, the health, social, and economic burden of Schizophrenia is very significant. In the last 10 years, several studies have analysed the economic burden of Schizophrenia, even if there is a lack of research that has considered the actual cost for the community as the result of each event in the patient's history. OBJECTIVE: The present study aims to cover this gap by proposing a novel model to evaluate better the cost of Schizophrenia with real data from medical records. METHODS: We applied (i) a 'real life' analysis of medical database to capture each event of the clinical history and healthcare that could have an economic impact; and (ii) a novel Activity-Based Costing model to quantify the overall annual economic burden of a patient with Schizophrenia treated by public mental health services. We carried out the study with 523 patients with a diagnosis of Schizophrenia in the Department of Mental Health of Bari, in the South of Italy. RESULTS: Our results reveal an overall cost of 41.290 per patient with Schizophrenia per year. Almost half of the cost is due to rehabilitation. The second most important factor is instead related to disability and loss of productivity. CONCLUSIONS: We believe that the present approach represents the most effective method to properly estimate actual costs when real-life data are available compared with other studies mainly based on prevalence-based approaches.
Asunto(s)
Servicios de Salud Mental , Esquizofrenia , Costo de Enfermedad , Costos de la Atención en Salud , Humanos , Prevalencia , Esquizofrenia/tratamiento farmacológico , Esquizofrenia/epidemiologíaRESUMEN
OBJECTIVE: Percutaneous correction of mitral regurgitation (MR) by MitraClip (Abbot Vascular, Abbot Park, Illinois, USA) trans-catheter procedure (MTP) may represent a treatment for an unmet need in heart failure (HF), but with a largely unclear economic impact. RESEARCH DESIGN AND METHODS: This study estimated the economic impact of the MTP in common practice using the disease-related group (DRG) billing system, duration and average cost per day of hospitalization as main drivers. Life expectancy was estimated based on the Seattle Heart Failure Model. Quality-of-life was derived by standard questionnaires to compute quality-adjusted year-life costs. RESULTS: Over 5535 discharges between 2012-2013, HF as DRG 127 was the main diagnosis in 20%, yielding a reimbursement of 3052.00/case; among the DRG 127, MR by ICD-9 coding was found in 12%. Duration of hospitalization was longer for DRG 127 with than without MR (9 vs 8 days, p < 0.05). HF in-hospital management generated most frequently deficit, in particular in the presence of MR, due to the high costs of hospitalization, higher than reimbursement. MTP to treat MR allowed DRG 104-related reimbursement of 24,675.00. In a cohort of 34 HF patients treated for MR by MTP, the global budget consumption was 2-fold higher compared to that simulated for those cases medically managed at 2-year follow-up. Extrapolated cost per quality-adjusted-life-years (QALY) for MTP at year-2 follow-up was â¼ 16,300. CONCLUSIONS: Based on DRG and hospitalization costing estimates, MTP might be cost-effective in selected HF patients with MR suitable for such a specific treatment, granted that those patients have a clinical profile predicting high likelihood of post-procedural clinical stability in sufficiently long follow-up.