Article Abstract

Article Abstract

Online ISSN: 1099-176X Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 16, Issue 1, 2013. Pages: 13-25
Published Online: 1 March 2013

The Societal Cost of Schizophrenia in Sweden

Mattias Ekman,¹ Ola Granström,² Sead Omérov,³ Johanna Jacob,⁴ Mikael Landén⁵

¹PhD, Associate Director, Health Economics and Outcomes Research, OptumInsight, Stockholm, Sweden
²PhD, Senior Health Economist, Department of Health Economics, AstraZeneca Nordic MC, Södertälje, Sweden
³MSc, Statistician, Northern Stockholm Psychiatry, Healthcare Provision, Stockholm County, Stockholm. Sweden
⁴PhLic, Senior Health Economist, Department of Health Economics, AstraZeneca Nordic MC, Södertälje, Sweden
⁵MD, PhD, Professor, Institute of Neuroscience and Physiology, University of Gothenburg, Sweden and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

* Correspondence to: Mattias Ekman, PhD, AstraZeneca Nordic, Department of Health Economics, SE-151 85 Södertälje, Sweden.
Tel.: +46-8-552-578 49
Fax: +46-8-553-295 88
E-mail: mattias.ekman@astrazeneca.com

Source of Funding: This study was supported by a grant from AstraZeneca. While the work on this study was performed, Mattias Ekman was an employee of OptumInsight (formerly i3 Innovus) and Ola Granström of AstraZeneca. ME is now an employee of AstraZeneca and OG of Gilead Sciences. Johanna Jacob is an employee of AstraZeneca. Mikael Landén is on the advisory board for AstraZeneca and Lundbeck, and has received speaker's fees from AstraZeneca, Eli Lilly, Lundbeck, and GlaxoSmithKline.

Abstract

The aims of this study were to investigate the societal cost per patient with schizophrenia in Sweden and to relate the costs to hospitalizations and global assessment of functioning (GAF). Individual-level data on health care resource use from a hospital-based registry (N=2161) were combined with individual-level national registry data on sick leave and early retirement. In 2008, the average cost per patient with schizophrenia was €42 700 (95% CI: €41 500 – 44 000). The cost of community mental health care was €12 400, giving a total cost of €55 100 per patient. The indirect cost was the largest cost item, representing 60% of the total cost. Costs were strongly related to hospitalization and GAF, suggesting that attempts to improve global functioning and avoid hospitalizations by means of effective treatment and rehabilitation might not only decrease suffering for patients and relatives, but also reduce the societal cost of schizophrenia.

Background: Schizophrenia is a disabling psychiatric disorder that has severe consequences for patients and their families. Moreover, the expensive treatment of schizophrenia imposes a burden on health care providers and the wider society. Existing cost estimates for Sweden, however, are based on relatively small patient populations and need to be confirmed in a large register-based study.

Aims of the Study: To investigate the health care resource utilization and cost-of-illness in patients with schizophrenia in Sweden and to relate the costs to hospitalizations and global assessment of functioning (GAF).

Methods: Hospital-based registry data were combined with national registry data from a large patient population to get reliable estimates of the costs of schizophrenia in Sweden. Schizophrenia was defined by ICD-10 codes F20; F21; F23.1,2,8,9; F25.1,8,9. Registry data on socio-demographics and disease-related healthcare resource use in outpatient and inpatient care were obtained from Northern Stockholm Psychiatry. Data on pharmaceuticals were obtained from the National Board of Health and Welfare, and data on sick leave and early retirement were obtained from the Swedish Social Insurance Agency. Costs for community mental health care were not available at the individual level, but were estimated based on previous studies and aggregate cost data from Stockholm. Resource use data from the registries were combined with unit costs from publicly available sources. The study was conducted from a societal perspective, with indirect costs valued according to the human capital method.

Results: The average annual psychiatric cost per patient with schizophrenia in 2008 was €42 700 (95% CI: €41 500 – 44 000), based on a sample of 2 161 patients. To this should be added costs for community mental health care of €12 400 per patient, giving a total cost of €55 100 per patient. The two largest cost items in the total costs were indirect costs due to lost productivity (60%) and community mental health care (22% of the total cost). Patients who were hospitalized in 2008 had greater psychiatric costs than those who were not, €71700 vs. €37 700 (p<0.0001). Psychiatric costs were significantly and negatively correlated with GAF (p<0.001).

Discussion: The major strengths of the study are the relatively large sample, and the linkage of patient-level clinical data on inpatient and outpatient care with national registry data on prescription pharmaceuticals, and days on social insurance. A limitation was that costs for informal care and primary care were not included in the data, but previous studies suggest that these costs items are small compared to other costs for schizophrenia.

Implications for Health Policies and Future Research: Costs were strongly related to hospitalization and GAF, suggesting that attempts to improve global functioning and avoid hospitalizations by means of effective treatment and rehabilitation might not only decrease suffering for patients and relatives, but also reduce the societal cost of schizophrenia. A detailed knowledge of the societal costs can also be helpful in evaluating the cost-effectiveness of new treatment strategies to improve the care for patients with schizophrenia.

Received 15 April 2011 ; accepted 23 February 2013