[The cost of schizophrenia in Germany: a systematic review of the literature].
ABSTRACT The aim of this study was a systematic literature review of cost-of-illness studies for schizophrenia in Germany.
We conducted a database search in Pubmed and PsychINFO. Cost data were inflated to the year 2007.
We finally included 11 studies in our review which show that schizophrenia causes societal cost of several billion Euros per year. After adjustment for inflation, costs per patient and year estimated between 1980 and 2002 tended to be relatively stable at around 14,000 to 18,000 Euro. Additionally, relatives are confronted with spending of 950 to 1,700 Euro due to the patients' disorder. Indirect costs are mainly due to early retirement or unemployment and amount to 25,000 to 30,000 Euro per patient when using the human capital approach. We found that changes in treatment settings and increasing costs of drug treatment seem to be reflected in published cost-of-illness studies.
When corrected for inflation, treatment cost per patient for schizophrenia show changes in their distribution over different cost sectors in the health care system but no substantial increases between 1980 and 2002.
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ABSTRACT: The purpose of this study is to analyse the effectiveness of flupentixol compared to other first- and second-generation antipsychotics for the treatment of schizophrenia in routine care. A retrospective cohort study was conducted using administrative data from four sickness funds covering 12.6 million insured. Patients discharged from hospital in 2003 with an ICD-10 diagnosis of schizophrenia were followed for 12 months. Rehospitalisation during follow-up was analysed using a hurdle regression model. Treatment costs were defined as cost of pharmaceutical and cost of inpatient care. Two thousand eight hundred ninety insured were included, of which 177 were treated with flupentixol during follow-up, while 429 and 2,284 were treated with other first-and second-generation antipsychotics, respectively. Compared to patients treated with flupentixol (21.0 days), predicted hospitalisation did not differ significantly for patients treated with other first- (21.3 days, p = 0.8313) or second-generation antipsychotics (25.6 days, p = 0.4035). Predicted treatment costs for the average patient were 4,193 Euro if treated with flupentixol, 4,846 Euro if treated with other first-generation antipsychotic, and 6,523 Euro if treated with a second-generation antipsychotic. Second-generation antipsychotics showed a clear advantage over flupentixol concerning extrapyramidal symptoms co-medication. The effectiveness of flupentixol preventing relapse in patients with schizophrenia appears to be similar to that of other first- and second-generation antipsychotics. However, the low treatment costs for patients treated with flupentixol could be explained by the small number of patients with readmissions (70 insured) and the larger share of patients treated with its depot formulation.Psychopharmacology 03/2011; 216(4):579-87. DOI:10.1007/s00213-011-2256-x · 3.99 Impact Factor
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ABSTRACT: OBJECTIVE: Interest in cardiovascular diseases (CVD) in schizophrenia has grown recently due to documented incremental mortality. C-reactive protein (CRP) has been assessed as a marker in individuals with CVD and/or at high risk of developing it. However, its role in schizophrenia patients is unknown. The goal of this research was thus to explore the use of CRP as a marker of CVD risk in patients with schizophrenia. METHODS: A cross-sectional analysis of the Badalona Serveis Assistencials (BSA) administrative claims database was conducted including all subjects aged>18 years with a diagnosis of schizophrenia spectrum disorder. CRP measurement, sociodemographics, medical history, 10-year CVD risk (Framingham function) and clinical chemistry data were extracted for analysis. RESULTS: Seven hundred and five patients (53.0% men, 48.2 [15.8] years, 78.7% on atypicals) met criteria for analysis. Mean 10-year CVD risk was high; 11.9±5.7% and mean CRP levels were 2.6±2.5mg/L with 30.4% showing above-normative levels (>3mg/L). After adjusting for age, gender, smoking and presence of neoplasm or inflammatory diseases, CRP was linearly associated with 10-year CVD risk stratified by risk (low, moderate, high/very high): respectively, 2.3 (95% CI: 2.1-2.5), 3.1 (2.6-3.5) and 3.7 (3.2-4.1) mg/L; F=13.5, P<0.001. Patients with known CVD also showed higher CRP levels: 3.7 (2.9-4.5) vs. 2.5 (2.4-2.7) mg/L, P=0.008; and higher probability of above-normal values; odds ratio=4.71 (2.01-11.04), P<0.001. CONCLUSIONS: High CRP levels above normative were associated with both known CVD and high/very high 10-year risk of a CVD event in patients with schizophrenia, suggesting CRP could be a marker of CVD in this psychiatric disorder.European Psychiatry 09/2011; 28(3). DOI:10.1016/j.eurpsy.2011.07.003 · 3.21 Impact Factor
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ABSTRACT: The aim of the study was to determine the costs of treating schizophrenia from the perspective of the statutory health insurance, as well as the identification of predictors of hospitalisation of formerly stable schizophrenia patients. Claims data for the years 2004-2006 were analysed. Patients who did not have to be treated in a hospital as a result of an ICD diagnosis F20 both in the year 2005 as well as also in 2006 were defined as stable patients. In contrast, those patients who had to be treated in a hospital in 2006 because of a diagnosis of schizophrenia were defined as unstable. In addition to the overall healthcare costs, the costs specific to schizophrenia were also analysed. Also, based on binary logistic regression analysis, predictors for hospital treatment were determined. 8497 stable and 1449 unstable patients were identified. The schizophrenia specific costs for stable patients were € 1605 and the overall costs were € 4029 in 2006, respectively. Unstable patients had indication-specific costs amounting to € 12864 and overall health care costs of € 16824. For unstable patients, the costs of hospital treatment were identified as being a substantial cost area. Predictors for a higher probability of hospital treatment were: female patients, at least one rehabilitation measure, at least one stay in hospital in 2004, and being co-morbid with substance abuse. In contrast, older patients, who were treated with concomitant medications, and if they received a continuous drug therapy in all quarters of a year had a lower probability of hospitalisation. In addition, an increased number of visits to a doctor reduced the probability of hospitalisation. The variable 'depot medication' were close to significance and the variable 'inability to work lasting more than six weeks' had, in contrast, no significant influence. The schizophrenia specific and overall health care costs of unstable patients were clearly higher than was the case with stable patients and mainly determined by inpatient hospital treatment. A range of potential predicting factors which can be extracted from routine claims data have a positive or negative influence on the probability of treatment in hospital.05/2012; 2(1):9. DOI:10.1186/2191-1991-2-9