Costs Of Psychiatric Care Research Articles

Comorbidity costs for the healthcare of mental patients

IntroductionMost patients with mental disorders exhibit multiple comorbidities. Without doubt the presence of multiple co-occurring somatic and mental disorders is associated with a higher insurance spending for the psychiatric patients. The details of this association need to be elucidated.ObjectivesThe aim of current study was 1) to delineate the typical nonmental comorbidities that occur among mental patients, and 2) to investigate social health insurance spending on comorbidities compared to the direct mental care costs of the same population. The analysis offers unique insight into the health care spending, since it focuses not only the costs of psychiatric care but reflects the whole range of treatments delivered to this group.MethodsA database with the claim records of the Hungarian NHIF was created including direct healthcare costs for mental diagnosis. Patients were recorded either in primary or in specialist care with at least one mental health diagnosis in the last pre-pandemic year (2019). Adopting a case-control design, spending and comorbidities were compared to the control group, which comprised patients who did not have any mental diagnosis. Cases and controls were matched on demographic characteristics like age, gender, place of residence with deprivation index and marital status..ResultsMental problems affected in 2019 more than 1,5 million persons in Hungary. Half of them did not access specialist care but were only seen with the mental diagnosis by a GP. Direct insurance spending for mental care is around 156 million EUR/year with 4% of the total direct health spending. Besides these costs another 665 million EUR (+17% of all health spending) were reimbursed for the same patient group for the treatment of other diseases. With regards to affected patient numbers, the three most important comorbidities were cardio-vascular conditions (34% of mental patients with 14% of all spending of the group); diseases of the digestive system (29% vs 14%); and musco-sceletal conditions (28% / 9% ) In terms of spending three other disease groups also have to be considered as of high significance: carcinomas (4% patients vs 13% of spending); neurological disorders (13% /vs 7%); and diseases of the endocrine, nutritional and metabolic system (24% vs 6%).ConclusionsThe analysis aims to raise awareness for the complex issues of comorbidities of mental patients. We see that this patient group suffers heavily from other conditions the costs of which is much higher than the direct mental care costs. A better understanding of the coexistence of somatic and mental disorders and a holistic approach of treatment (care integration, reimbursement across different types of care, etc.) would be desirable.Disclosure of InterestNone Declared

Matching ICD-11 personality status to clinical management in a community team-The Boston (UK) Personality Project: Study protocol.

Epidemiological studies show 30% to 50% of all patients in community mental health teams have personality disorders. These are normally comorbid with other psychiatric disorders, often as Galenic syndromes, and are seldom identified. In the Boston (UK) Personality Project all patients under a community health service in Boston in Lincolnshire will be asked to agree to have their personality status assessed using scales recording the new ICD-11 classification, together with clinical ratings, social function and satisfaction. A control group of 100 patients from an adjacent service of similar demographics (Spalding) will also have similar ratings but no personality assessments. Changes in clinical status, social function and service satisfaction will be made after 6 and 12 months in both groups. The patients in the Boston group will be offered matched interventions using a stepped care approach for both the severity of disorder and its domain structure. These interventions will include shorter versions of existing psychological treatments, environmental therapies including nidotherapy, adaptive and acceptance models, drug reduction and social prescribing. Full costs of psychiatric care will be measured in both groups. The main hypothesis is that greater awareness of personality function will lead to better clinical outcomes and satisfaction.

The cost of child abuse and neglect in France: The case of children in placement before their fourth birthday

BackgroundDespite the high prevalence of child abuse and neglect and its consequences on health, very few studies have evaluated the trajectories of children in placement in France, and there are no cost studies available. ObjectiveTo estimate the cost of abuse and neglect in children in placement before their 4th birthday in France. Participants and settingA cohort of children in placement before their 4th birthday in a single nursery between February 1994 and June 2001 was followed from birth until they left care. MethodsChild protective services (CPS), health, health and social, and judiciary services utilization was derived from a qualitative analysis of the children's files and valued with their unit costs in 2013 euros from the societal perspective. Total costs and mean annual cost per child followed by CPS were calculated overall, by cost category, and by status at admission to the nursery. Results129 children were included. Mean age at first admission was 1.9 years (SD = 1.3). The mean length of follow-up by CPS was 14.3 years (SD = 5.0). Mean annual cost per child was estimated at €53,265 (SD = 42,077), with CPS costs representing 78% of costs. 80% of health care costs were due to psychiatric care. Children with no identified psychosocial risk factors had significantly higher psychiatric care costs and health and social care costs than pre-term children and children with identified psychosocial risk factors. ConclusionMore research should be carried out to address early and comprehensively the multiple needs of children followed by CPS in the short- and long-term.

Brexpiprazole reduces costs of psychiatric care in the US

Brexpiprazole reduces costs of psychiatric care in the US

Depressive disorders in adolescence, recurrence in early adulthood, and healthcare usage in mid-adulthood: A longitudinal cost-of-illness study

BackgroundDepression in adolescence is associated with increased healthcare consumption in adulthood, but prior research has not recognized the heterogeneity of depressive disorders. This paper investigated the additional healthcare usage and related costs in mid-adulthood for individuals with adolescent depression, and examined the mediating role of subsequent depression in early adulthood. MethodsThis study was based on the Uppsala Longitudinal Adolescent Depression Study, initiated in Sweden in the early 1990s. Depressive disorders were assessed in adolescence (age 16–17) and early adulthood (age 19–30). Healthcare usage and related costs in mid-adulthood (age 31–40) were estimated using nationwide population-based registries. Participants with specific subtypes of adolescent depression (n = 306) were compared with matched non-depressed peers (n = 213). ResultsWomen with persistent depressive disorder (PDD) in adolescence utilized significantly more healthcare resources in mid-adulthood. The association was not limited to psychiatric care, and remained after adjustment for individual and parental characteristics. The total additional annual cost for a single age group of females with a history of PDD at a population level was estimated at 3.10 million USD. Depression recurrence in early adulthood mediated the added costs for psychiatric care, but not for somatic care. LimitationsPrimary health care data were not available, presumably resulting in an underestimation of the true healthcare consumption. Estimates for males had limited precision due to a relatively small male proportion. ConclusionsOn a population level, the additional healthcare costs incurred in mid-adulthood in females with a history of adolescent PDD are considerable. Early treatment and prevention should be prioritized.

Costs of Mental Health Services in Czechia: Facilitating an Evidence-Based Reform of Psychiatric Care.

Information about unit costs of psychiatric care is largely unavailable in Central and Eastern Europe, which poses an obstacle to economic evaluations as well as evidence-based development of the care in the region. The objective of this study was to calculate the unit costs of inpatient and community mental health services in Czechia and to assess the current practices of data collection by mental healthcare providers. We used bottom-up microcosting to calculate unit costs from detailed longitudinal accounts and records kept by three psychiatric hospitals and three community mental health providers. An inpatient day in a psychiatric hospital costs 1504 Czech koruna (CZK; €59), out of which 75% is consumed by hotel services and the rest by medication and therapies. The costed inpatient therapies include individual therapies provided by a psychiatrist or psychologist, consultations with a social worker, group therapies, organised cultural activities and training activities. As regards the community setting, we costed daycare social facilities, case management services, sheltered housing, supported housing, crisis help, social therapeutic workshops, individual placement and support, and self-help groups. The unit costs enable assigning financial value to individual items monitored by the Czech version of the Client Service Receipt Inventory, and thus estimation of costs associated with treatment of mental health problems. The employed methodology might serve as a guideline for the providers to improve data collection and to calculate costs of services themselves, with this information likely becoming more crucial for payers in the future.

Factors Associated with Costs of Hospitalization of Severely Mentally Ill Patients

Background: Efforts to contain costs associated with general medical care include particular efforts for psychiatric disorders. Hospitalization represents the largest component of costs for psychiatric care and there is growing interest in balancing clinical needs against limiting costs of inpatient psychiatric care of patients with severe mental illnesses. This study aimed to evaluate clinical factors associated with actual costs of inpatient psychiatric care. Method: We evaluated a cohort of 589 hospitalized psychiatric patients with severe mental illnesses at a nonprofit, university-affiliated psychiatric hospital for factors associated with annualized total costs of inpatient care over a three-year period, using bivariate and multivariate analyses. Results: As expected, days-hospitalized was the major determinant of total costs of hospital care. In addition, several clinical and treatment factors also were associated significantly and independently with costs in multivariate modeling. These included presence of psychosis, electroconvulsive treatment, specialist consultations, use of multiple antipsychotics or of clozapine, and being discharged to a supervised living arrangement, but not sex, age, marital status, employment, or substance abuse. Discussion: As expected, costs of psychiatric hospitalization were dominated by per-diem charges, but also influenced by other, potentially modifiable treatment factors generally associated with more severe psychotic illnesses. The study is based on actual costs rather than on insurer-reimbursements and a large study-sample, though at a single institution. Specific factors identified encourage focusing on patient characteristics associated with greater costs and redoubled efforts to apply and improve alternative, cost-effective interventions such as partialhospital and intensive outpatient treatment.

LAT software induced savings on medical costs of alcohol addicts' care--results from a matched-pairs case-control study.

Lesch Alcoholism Typology (LAT) is one of the most widely used clinical typologies of alcohol addiction. Study tested whether introduction of LAT software in clinical practice leaded to improved outcomes and reduced costs. Retrospective matched-pairs case-control cost comparison study was conducted at the Regional Addiction Center of the University Clinic in Serbia involving 250 patients during the four-year period. Mean relapse frequency followed by outpatient detoxification was 0.42±0.90 vs. 0.70±1.66 (LAT/non-LAT; p = 0.267). Adding relapses after inpatient treatment total mean-number of relapses per patient was 0.70±1.74 vs. 0.97±1.89 (LAT/non-LAT; p = 0.201). However, these relapse frequency differentials were not statistically significant. Total hospital costs of Psychiatry clinic based non-LAT addicts' care (€54,660) were significantly reduced to €36,569 after initiation of LAT. Mean total cost per patient was reduced almost by half after initiation of LAT based treatment: €331±381 vs. €626±795 (LAT/non-LAT; p = 0.001). Mean cost of single psychiatry clinic admission among non-LAT treatment group was €320±330 (CI 95% 262–378) and among LAT €197±165 (CI 95% 168–226) (p = 0.019). Mean LAT software induced net savings on psychiatric care costs were €144 per patient. Total net savings on hospital care including F10 associated somatic co-morbidities amounted to €295 per patient. More sensitive diagnostic assessment and sub-type specific pharmacotherapy and psychotherapy following implementation of LAT software lead to significant savings on costs of hospital care.

Workplace effectiveness and psychotherapy for mental, substance abuse, and subsyndromal conditions.

While it is known that psychiatric illness and subclinical psychiatric illness can be very disabling, their impact on workers' productivity has been little appreciated or appropriately addressed. Complex variables are involved in fashioning an appropriate policy to ameliorate the impact of mental illness on productivity including the identification of effective treatments and potential negative effects of controlling patients' access to them. The cost-effectiveness of such treatments is considered from the differing perspectives and goals of the various stakeholders involved, including employers, insurers, and workers with psychiatric illness. Depression in workers leads to significant absenteeism, "presenteeism" (diminished capacity due to illness while still present at work), and significantly increased medical expenses in addition to the costs of psychiatric care. In addition to the specific usefulness of psychotropic medication, there are a variety of studies on the cost-effectiveness of different psychotherapeutic treatments that improve health and productivity in psychiatrically ill workers. Research indicates the usefulness of approaches including employee assistance programs, specialized cognitive-behavioral treatments, and brief and longer term psychodynamic interventions. It is clear that substance abuse disorders and especially depression and subsyndromal depression have a profound negative effect on work productivity and increases in medical visits and expenses. The current system of mental health care suffers from ignorance of the negative effects of psychiatric illness in workers, from a lack of subtle awareness of which treatments are most appropriate for which diagnoses and from the reluctance by payers to invest in them. Access to evidence-based appropriate treatment can improve the negative impact on productivity as well as workers' health. This article considers these issues and argues for a role of psychotherapy in the treatment of mental illness and substance abuse from the perspective of worker productivity.

Does psychoanalytic psychotherapy offset use of mental health services and related costs in severe borderline personality disorder? – A case study

Aims and methods: To show that long-term psychoanalytic psychotherapy can offset costs of psychiatric care when offered to a patient affected by borderline personality disorder with a severe presentation and co-morbid psychopathologies. Costs of mental health services were calculated for a nine-year period. Cost offset was calculated comparing the five years preceding therapy with the four years during and post-therapy. Results: In this case study the provision of long-term psychoanalytic psychotherapy has consistently and progressively reduced use of mental health services and related costs during the intervention and post-intervention period. Significant reduction in use of services and savings of approximately £5000 were obtained for the post-intervention year. Limitations: The research findings are limited by the lack of control conditions over confounding factors. Besides, cost-effectiveness could not be established. Clinical implications: Long-term psychoanalytic psychotherapy is rarely available in the modern National Health Service (NHS) and is unlikely to be offered to patients with severe character pathology. Although specialist tertiary services have been created to cater for this group, patients who cannot engage with these services risk not to be adequately treated. This case study suggests that long-term psychoanalytic psychotherapy could be used as a viable and cost-saving alternative for some of these patients.

1775 – Economic impact of antidepressant treatment duration in a real-life setting

The benefit-risk ratio of a long duration of antidepressant drug treatment (ADT) may not be favourable. A pragmatic way to study the consequences of ADT duration in accordance with practice guidelines is to assess its impact on health care use. To assess the economic impact of ADT duration in a real-life setting through the changes in direct health care costs. A historical fixed cohort study included 27,134 patients aged 18 and over with a new ADT registered in the national insurance database. The economic impact concerned health care expenditure in the first three months after treatment discontinuation. Generalized linear models compared two groups of treatment duration: less than six months and six months and over. After adjustment for care costs before and during ADT, gender, age, chronic diseases, welfare entitlement and prescriber specialty, total health care costs (in log) [-0.06 (-0.14;0.01) p = 0.11] and psychiatric care costs (in square root) [-0.08 (-0.41;0.25) p = 0.6] were similar in both groups after ADT discontinuation. Non-psychiatric care costs were significantly lower in the “long treatment duration” group compared with the “short treatment duration” group [-11.4 (-15.8;-7.0) p < 0.0001]. The decreases in total and non-psychiatric care costs after the ADT episode were larger in the “long treatment duration” group compared with the “short treatment duration” group. With regard to health care costs and global health, ADT of short duration appear less effective than treatment of recommended duration.

Economic impact of antidepressant treatment duration in naturalistic conditions

To assess the economic impact of the duration of antidepressant drug treatment in a real-life setting. A historical fixed cohort study included 27 917 patients aged 18 and over with a new antidepressant treatment registered in the national insurance database. The economic impact concerned healthcare expenditure in the first 3 months after treatment discontinuation. Generalized linear models were used to compare two groups of treatment duration: <6 months and 6 months and over. After adjustment for care costs before and during treatment episode, gender, age, chronic diseases, welfare and prescriber specialty, total healthcare costs (in log) [-0.06 (-0.14;0.01) P = 0.11] and psychiatric care costs (in square root) [-0.08 (-0.41;0.25) P = 0.6] were similar in both groups. Non-psychiatric care costs were significantly lower in the 'long treatment duration' group compared with the 'short treatment duration' group [-11.4 (-15.8; -7.0) P < 0.0001]. The decreases in total and non-psychiatric care costs over the antidepressant treatment episode were larger in the 'long treatment duration' group compared with the 'short treatment duration' group. With regard to healthcare costs and global health, antidepressant drug treatments of short duration appear less effective than treatment of recommended duration.

The psychiatric profile of the U.S. patient population across age groups

Introduction: As the U.S. population undergoes continuous shifts the population’s health profile changes dynamically resulting in more or less expression of certain psychiatric disorders and utilization of health-care resources. In this paper, we analyze national data on the psychiatric morbidity of American patients and their summated cost in different age groups. Methods: The latest data (2009) on the number of hospital discharges and national bill (hospital charges) linked with psychiatric disorders were extracted from the Nationwide Inpatient Sample (NIS). Results: National data shows that mood disorders are the largest diagnostic category in terms of percentage of psychiatri-crelated discharges in the 1 - 17 years age group. The proportion decreases gradually as age progresses while delirium, dementia, amnestic and other cognitive disorders increase exponentially after 65 years of age. Schizophrenia and other psychotic disorders as well as alcohol and substance-related disorders peak in the working age groups (18 - 64 years). From an economic point of view, mood disorders in the 18 - 44 age group has the highest national bill ($5.477 billion) followed by schizophrenic and other psychotic disorders in the same age group ($4.337 billion) and mood disorders in the 45 - 64 age group ($4.310 billion). On the third place come schizophrenic and other psychotic disorders in the 45 - 64 age group ($3.931 billion). Conclusion: This paper illustrates the high cost of psychiatric care in the U.S., especially the large fraction of healthcare money spent on working-age patients suffering from mood disorders. This underlines psychiatric cost-efficiency as a vital topic in the current healthcare debate.

Relationships Among Depression, Chronic Pain, Chronic Disabling Pain, and Medical Costs

Although evidence suggests that patients with depression use more medical services than those without depression, few studies have examined whether specific subgroups of patients with depression have higher utilization than others. The study compared costs for general medical care with and without psychiatric care for patients with major depression and disabling chronic pain (reference group) with costs for five other groups: those with depression and nondisabling chronic pain, those with major depressive disorder alone, those with no depression who had disabling chronic pain, those with depression who had chronic pain that was not disabling, and those who had neither pain nor depression. Costs for the group with major depressive disorder alone were compared to costs for the three groups without depression. A questionnaire assessing major depressive disorder, chronic pain, and pain-related disability was mailed to a random sample of Kaiser Permanente patients who visited a primary care clinic. A total of 5,808 patients responded (54% participation rate). Costs for a two-year period were obtained from Kaiser Permanente's Cost Management Information System. Analyses were adjusted for presence of any of four major chronic medical illnesses. Total costs for patients in the reference group were significantly higher than costs for the other five subgroups. Regression analyses indicated that continuous measures of severity of pain and severity of depression were associated with increased costs, but no statistically significant interaction of depression and pain on total cost was observed. Patients with major depressive disorder and comorbid disabling chronic pain had higher medical service costs than other groups of patients with and without depression. However, findings suggest that the increases in cost from having both pain and depression are additive and not multiplicative.

Relationships Among Depression, Chronic Pain, Chronic Disabling Pain, and Medical Costs

Relationships Among Depression, Chronic Pain, Chronic Disabling Pain, and Medical Costs

Résultats de l'évaluation médico-économique d'un secteur de psychiatrie (1995-1997)

A health economics study was carried out from 1995 ? 1997 on the public sector of psychiatry in order to explore the variables which contribute to the differences in the cost of psychiatric care. The results show that the costs are independent of the pathology, but they correlate to the level of medical-social dependence and to the existence (or not) of family and social support structures. The most expensive care per year is that of patients diagnosed with dementia, intellectual deficiencies, or problems of schizophrenia. If the sociological variables of sex, age and professional category are highly significant in the redistribution of cost, these are independent of the quality and provision of care, measured by a comprehensive, overall operational scale (EGF). 10% of patients consume 75% of the available resources but only 50% of the ambulatory care. The definitive costs are ultimately influenced by hospitalization. The increase in the number of patients actively seeking treatment and the increase in ambulatory care provided levels out year after year for which there is a noted decrease in full time hospitalization. Regardless of the diagnosis, full time hospital care carries the same cost. Therefore, the 10% of patients for whom care is most expensive are those who have been diagnosed with CIM 10, schizophrenic patients representing less than half of them.

A Randomized Controlled Trial of a Private-Sector Inpatient-Initiated Psychoeducation Program for Schizophrenia

A Randomized Controlled Trial of a Private-Sector Inpatient-Initiated Psychoeducation Program for Schizophrenia

Das Regionale Psychiatriebudget: Kosten und Effekte eines neuen sektorübergreifenden Finanzierungsmodells für die psychiatrische Versorgung

To evaluate a new multi-sector financing model for psychiatric care based on the capitation principle (Regional Psychiatry Budget, RPB). Patients with a diagnosis according to ICD-10 F10, F2, and F3 were interviewed in the model region (MR, N=258) and a control region (CR, N=244) financed according to the fee-for-service principle. Effectiveness of care was assessed before RPB-introduction and after 1.5 years. Use of care was determined semi-annually. Costs of inpatient psychiatric treatment decreased more strongly in the MR, while hospital based outpatient care and day clinic treatment were intensified in comparison to the CR. Quality of life, severity of illness and illness-specific symptoms in patients improved similarly in MR and CR. The functional level improved more in the MR than in the CR, which was especially evident in schizophrenia patients. Inpatient psychiatric care costs can be reduced with the RPB without compromising the quality of care.

Psychiatric Morbidity and Parental Substance Use Disorder

Objective: To assess psychiatric morbidity associated with having no, one, or two parents with Substance Use Disorder (SUD), among patients receiving SUD care. Design: Two measures of psychiatric morbidity included (a) current psychopathology and (b) lifetime use of psychiatric treatment. Settings: Alcohol-drug treatment programs were located in two university medical centers. Subjects: Four hundred ninety-five voluntary patients aged 18 and older and non-adopted. Results: Parental SUD was directly related to (a) more current psychiatric symptoms, both self-rated and psychiatrist-rated and (b) greater likelihood of ever having ever received psychiatric treatment. Among those who had ever received psychiatric care, the number of psychotropic medications was related to parental SUD. Number of admissions, venues, visits/days, and cost of psychiatric care were not associated with parental SUD. Conclusions: Extent of parental SUD was related to increased psychiatric morbidity.

Paediatric psychiatric care costs high, varied in the UK

Paediatric psychiatric care costs high, varied in the UK