ArticlePDF Available

Cost of mental and behavioural disorders in Kenya

Authors:
  • African Sustainable Development Research Consortium, Nairobi, Kenya

Abstract

Background The health and economic impact of mental and behavioural disorders (MBD) is wide-ranging, long-lasting and large. Unfortunately, unlike in developed countries where studies on the economic burden of MBD exist, there is a dearth of such studies in the African Region of the World Health Organization. Yet, a great need for such information exists for use in sensitizing policy-makers in governments and civil society about the magnitude and complexity of the economic burden of MBD. The purpose of this study was to answer the following question: From the societal perspective (specifically the families and the Ministry of Health), what is the total cost of MBD patients admitted to various public hospitals in Kenya? Methods Drawing information from various secondary sources, this study used standard cost-of-illness methods to estimate: (a) the direct costs, i.e. those borne by the health care system and the family in directly addressing the problem of MBD; and (b) the indirect costs, i.e. loss of productivity caused by MBD, which is borne by the individual, the family or the employer. The study was based on Kenyan public hospitals, either dedicated to care of MBD patients or with a MBD ward. Results The study revealed that: (i) in the financial year 1998/99, the Kenyan economy lost approximately US$13,350,840 due to institutionalized MBD patients; (ii) the total economic cost of MBD per admission was US$2,351; (iii) the unit cost of operating and organizing psychiatric services per admission was US$1,848; (iv) the out-of-pocket expenses borne by patients and their families per admission was US$51; and (v) the productivity loss per admission was US$453. Conclusions There is an urgent need for research in all African countries to determine: national-level epidemiological burden of MBD, measured in terms of the prevalence, incidence, mortality, and, probably, the disability-adjusted life-years lost; and the economic burden of MBD, broken down by different productive and social sectors and occupations of patients and relatives.
BioMed Central
Page 1 of 7
(page number not for citation purposes)
Annals of General Hospital
Psychiatry
Open Access
Primary Research
Cost of mental and behavioural disorders in Kenya
Joses M Kirigia* and Luis G Sambo
Address: Health Economics Programme, World Health Organization, Regional Office for Africa, B.P. 06, Brazzaville, Congo
Email: Joses M Kirigia* - kirigiaj@afro.who.int; Luis G Sambo - sambol@afro.who.int
* Corresponding author
Abstract
Background: The health and economic impact of mental and behavioural disorders (MBD) is
wide-ranging, long-lasting and large. Unfortunately, unlike in developed countries where studies on
the economic burden of MBD exist, there is a dearth of such studies in the African Region of the
World Health Organization. Yet, a great need for such information exists for use in sensitizing
policy-makers in governments and civil society about the magnitude and complexity of the
economic burden of MBD. The purpose of this study was to answer the following question: From
the societal perspective (specifically the families and the Ministry of Health), what is the total cost
of MBD patients admitted to various public hospitals in Kenya?
Methods: Drawing information from various secondary sources, this study used standard cost-of-
illness methods to estimate: (a) the direct costs, i.e. those borne by the health care system and the
family in directly addressing the problem of MBD; and (b) the indirect costs, i.e. loss of productivity
caused by MBD, which is borne by the individual, the family or the employer. The study was based
on Kenyan public hospitals, either dedicated to care of MBD patients or with a MBD ward.
Results: The study revealed that: (i) in the financial year 1998/99, the Kenyan economy lost
approximately US$13,350,840 due to institutionalized MBD patients; (ii) the total economic cost
of MBD per admission was US$2,351; (iii) the unit cost of operating and organizing psychiatric
services per admission was US$1,848; (iv) the out-of-pocket expenses borne by patients and their
families per admission was US$51; and (v) the productivity loss per admission was US$453.
Conclusions: There is an urgent need for research in all African countries to determine: national-
level epidemiological burden of MBD, measured in terms of the prevalence, incidence, mortality,
and, probably, the disability-adjusted life-years lost; and the economic burden of MBD, broken
down by different productive and social sectors and occupations of patients and relatives.
Background
"..mental health affects all spheres of human endeavour and
that there is no health without mental health. .. Ministers (of
Health at the 54
th
World Health Assembly) agreed that rais-
ing the level of awareness is the first priority. Policy-makers in
government and civil society need to be sensitized about the
huge and complex nature of the economic burden of MBD and
the need for more resources to treat MBD."
Senator the Hon. Phillip C. Goddard, Minister of Health,
Barbados [1].
Published: 10 July 2003
Annals of General Hospital Psychiatry 2003, 2:7
Received: 23 March 2003
Accepted: 10 July 2003
This article is available from: http://www.general-hospital-psychiatry.com/content/2/1/7
© 2003 Kirigia and Sambo; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in
all media for any purpose, provided this notice is preserved along with the article's original URL.
Annals of General Hospital Psychiatry 2003, 2 http://www.general-hospital-psychiatry.com/content/2/1/7
Page 2 of 7
(page number not for citation purposes)
The historical marginalization of mental health from
mainstream health and welfare services in many countries
has contributed to endemic stigmatization and discrimi-
nation of MBD people [2]. As a result, mental health has
received low priority in health policy development, health
services, psychiatric human resource development and
resource allocation. Yet, worldwide, mental and neurolog-
ical conditions account for a substantive proportion of the
global burden of disease. For example, in 1999, neuropsy-
chiatric disorders resulted in 911,000 deaths and a loss of
158.7 million disability-adjusted life-years (DALYs)
among the 191 WHO Member States [3]. Approximately,
9% of those deaths and 10% of the lost DALYs occurred
in the WHO's African Region. Of the latter DALY losses,
35.5% were attributed to unipolar major depression,
10.2% to bipolar affective disorder, 3.5% to psychoses,
11.6% to epilepsy, 13.2% to alcohol dependence, 2.3% to
Alzheimer's disease and other dementia, 0.5% to Parkin-
son's disease, 0.7% to multiple sclerosis, 2.8% to drug
dependence, 1.5% to post-traumatic stress disorder, 7.3%
to obsessive-compulsive disorders, 3.4% to panic disorder
and 7.6% to other neuropsychiatric disorders.
Groups at a higher risk of developing mental and behav-
ioural disorders (MBD) include people with serious or
chronic physical illnesses, children and adolescents with
disrupted upbringing, people living in poverty or difficult
conditions, the unemployed, female victims of violence
and abuse, and the neglected elderly persons [2]. To these
we would add victims of natural (e.g. floods) and man-
made (e.g. civil wars) disasters, and those whose human
rights are recurrently violated.
The economic impact of MBD is wide-ranging, long-last-
ing and large [2]. It includes: the cost of organizing and
operating mental health-related services; the impact on
the families' and care-givers' resources; the expenses
related to crimes caused by the MBD; the productivity
losses due to debility, morbidity and premature death;
and the psychological pain borne by the patients and their
family members. A number of researchers, mainly from
developed countries, have estimated the aggregate eco-
nomic costs of MBD. Osterhaus et al. [4] estimated that
mental disorders costed the USA about US$42.3 billion in
1990. Rice et al. [5] estimated that mental disorders
accounted for approximately 2.5% of the gross national
product per year in USA. Meerding et al. [6] estimated that
23.2% of total annual health service expenditure in Neth-
erlands goes to the treatment of mental disorders. Patel
and Knapp [7] estimated that inpatient treatment of men-
tal disorders accounts for 22% of the annual national
health service expenditure in UK. Unfortunately, unlike in
North America and Europe, there is a dearth of studies
that have attempted to estimate the economic burden of
MBD in the African Region [8].
This article focusses on the economic burden of MBD. It
attempts to answer the question: From the societal per-
spective (specifically the families and the Ministry of
Health), what is the total cost of MBD patients admitted
to various public hospitals in Kenya? The specific objec-
tives were to estimate: (a) the direct costs, i.e. those borne
by the health-care services and the families in directly
addressing the problem; and (b) the indirect costs, i.e.
mainly the losses in productivity caused by the disease,
borne by the individual, the family or the employer.
Methods
Study site
Like elsewhere in the African Region where the prevalence
and extent of poverty is high, MBD is a major public
health problem in Kenya. It is estimated that over 30% of
the people attending health facilities in the country suffer
from some form of MBD, with many of them going largely
unrecognized and receiving inappropriate treatment [9].
A majority of MBD patients are treated at the Mathare Psy-
chiatric Hospital and in general hospitals with psychiatric
wards, e.g. in Kakamega, Nakuru, Murang'a, Nyeri, Mach-
akos, Mombasa, Kisumu, Eldoret and Gilgil. The Mathare
Hospital is the largest psychiatric facility in the country
with 1,043 beds, of which 61% are general care beds and
39% maximum security beds. In 1999, a total of 5,678
inpatients (49% of whom were female) were treated at the
aforementioned hospitals. About 24% of them were hos-
pitalized at the Mathare Psychiatric Hospital; 42%, 52%
and 6% of the patients fell within the age brackets of 10–
25 years, 25–49 years and 50 years and above respectively.
Nearly 4.5% of the patients died during treatment [10].
The estimates of the economic burden reported in this
study are based on the 5,678 inpatient cases of MBD.
Conceptual framework
Definition of costs estimated
The economic burden of MBD comprises direct costs,
indirect costs and intangible costs. Direct costs has two
strands. Firstly, the costs to the government of organizing
and operating psychiatric hospital services: personnel
remunerations (including salaries and fringe benefits);
travel; transport operations; materials (e.g. consumable
materials, uniforms, hospital linen, stationery, medical
records); drugs; non-pharmaceutical supplies (e.g. dress-
ings and other disposable inputs); administration
(including expenses of boards, committees and confer-
ences); utilities (i.e. electricity, water, telephone, postage
and conservancy); kitchen (including food and gas
expenses); diagnostics (clinical laboratory and imagery);
maintenance (of vehicles, equipment and buildings);
rents and rates; and capital costs (i.e. purchase of vehicles,
beds, equipment and buildings) [11]. The capital items
were annuitized assuming a useful life span of 30 years for
buildings, 10 years for equipment and vehicles [12]. A
Annals of General Hospital Psychiatry 2003, 2 http://www.general-hospital-psychiatry.com/content/2/1/7
Page 3 of 7
(page number not for citation purposes)
10% discount rate was used to annuitize capital costs. It is
the rate that has been used in other costing studies under-
taken in Kenya [12,13]. Thus, the annual equivalent costs
for buildings, equipment and vehicles were obtained by
dividing their replacement values by the appropriate
annuity factors. Secondly, the out-of-pocket expenses
borne by the patients and their families, including: return-
journey bus fare for patients, accompanying persons and
visitors; lunch and dinner expenses when visiting patients;
accommodation expenses during visits; user fees for treat-
ment; X-ray fees; laboratory tests fees; official mortuary
fees and informal mortuary attendants' payments (for
patients who die during treatment); and funeral expenses,
e.g. transportation of bodies and the accompanying peo-
ple [14].
The indirect costs consist of opportunity cost of time lost
due to morbidity and premature mortality. The morbid-
ity-related component includes the productivity losses of
time invested by patients in pre-admission consultations,
travel to and from hospitals, waiting for admission, and
during institutionalized treatment; by relatives accompa-
nying patients during pre-admission consultations, travel
to and from hospitals accompanying patient(s), waiting
for patients to be admitted, and visiting patients after
admission. The confirmatory diagnostic tests are per-
formed after admission. Thus, the diagnostic, treatment,
side-effects monitoring and treatment times are all cap-
tured within the duration of stay [14].
The premature mortality-related cost component is equal
to the lost work-years due to premature death (i.e.
national retirement age minus age at death) times average
remuneration per year. A casual labour wage rate of
US$1.00 per day (which is also equivalent to the interna-
tional poverty line) was used for valuing all the lost labour
time.
Intangible costs refer to welfare losses due to the physical
and psychological pain. Due to the stigma attached to
MBD, the related psychic and social costs to the affected
families can be profound. For example, in most Kenyan
communities, most people are very reluctant to marry into
families with a history of MBD. As a result, many young
men and women from families with a history of MBD
often find it difficult to get marriage partners. Time con-
straints prohibited the collection of willingness-to-pay
data that would have facilitated the estimation of intangi-
ble costs.
Analytical model
The total economic cost (TEC) incurred by MBD patients
and relatives can be expressed as follows:
TEC = DC + IC + ITC ........................... (1)
where: DC is direct cost, IC is indirect cost (which is pro-
ductivity loss) and ITC is intangible cost (including phys-
ical and psychological pain).
The total direct cost (DC) was estimated using equations
2 to 10:
DC = COO + OoPE ................................ (2)
where: COO are the total costs borne by government in
operating and organizing mental hospital services; and
OoPE are the out-of-pocket expenses borne by patients,
family members and relatives.
COO = P + FB + TOE + TE + U + BCC + DR + FO + NP +
MA + ME + RR + KC .............................. (3)
where: P is personnel remunerations; FB is fringe benefits;
TOE is transport operating expense; TE is travel expense; U
is cost of utilities; BCC is the expense of hospital boards,
committees and conferences; DR is the cost of drugs; FO
is the cost of food and cooking gas; NP is the cost of non-
pharmaceutical supplies; MA is the cost of materials; ME
is the cost of vehicles, equipment and building mainte-
nance; RR is the rent and rates; and KC is the annual
equivalent cost of capital items. The raw data for COO
components was obtained from the Government of Kenya
[11] recurrent and development expenditure estimates.
OoPE = L + D + A + F + UF + OF ............... (4)
where: L is lunch cost during visits, D is visitors' dinner
cost, A is visitors' accommodation cost, F is travel cost
(bus fare), UF is the average user fees, and OF is other fees;
L = NA × NL × NVs × CL ............................... (5)
where: NA is the number of admissions, NL is the number
of lunches per trip, NVs is the number of visits, and CL is
the average cost per lunch;
D = NA × ND × NVs × CD ............................ (6)
where: ND is the number of dinners per trip, NVs is the
number of visits, and CD is the average cost per dinner;
A = NA × NV × NVs × NN × CN ....................(7)
where: NV is the number of visitors, NN is the number of
nights spent in a town where a hospital is situated, and
CN is the average cost per night;
F = NA × NV × NVs × CF ...............................(8)
where: CF is the average return fare per person per visit;
Annals of General Hospital Psychiatry 2003, 2 http://www.general-hospital-psychiatry.com/content/2/1/7
Page 4 of 7
(page number not for citation purposes)
UF = NA × ALS × UFPD ...............................(9)
where: ALS is the average length of hospitalization in days
and UFPD is the average user fees per day; and
OF = NA × OF
ALS
...........................................(10)
where: OF
ALS
is the other fees per average length of stay.
The total indirect costs (IC) were obtained using the fol-
lowing algorithm:
IC = L
H
+ L
V
.................................................. (11)
where: L
H
are the productivity losses due to work days lost
by patients and L
V
is the productivity loss due to the work-
time lost by relatives accompanying and visiting patients;
L
H
= NA × ALOS × WR ....................... (13)
where: WR is the wage rate per hour or day; and
L
V
= NA × NV × NVs × TV × WR .......... (14)
where: TV is the time spent by a visitor per visit. This
includes the time spent travelling, waiting and socializing
with a patient at a hospital.
The total intangible costs (ITC) were not estimated in this
study. The estimations for out-of-pocket expenses and
productivity losses incurred by patients and their families
were based on two sets of assumptions: first, those related
to patients from within the district where the hospital is
situated; and second, those related to patients admitted
from other districts. Both sets of assumptions are con-
tained in the Appendix. Those assumptions are based on
past Kenyan health facility-based studies [9,14].
Limitations of the study
(a) Omission of intangible costs
Due to research resource constraints, data used in this
study were obtained mainly from secondary sources.
Thus, it was not possible to collect willingness-to-pay data
that would have facilitated the estimation of intangible
costs, i.e. the costs of physical and psychological pain and
loss of leisure time. However, they can potentially be esti-
mated using the following algorithm:
ITC = NA × WTP ................................(15)
where: NA is as defined previously and WTP is the average
amount of money (or its equivalent in goods or services)
that each patient's family would be willing to pay for an
intervention that would obviate any form of MBD, and
hence the associated stigma and pain. Readers who are
interested in knowing how to elicit WTP values in an Afri-
can context can refer to Kirigia, Sambo and Kainyu [15].
(b) Use of casual-labour wage rate to value lost labour time
A casual-labour wage rate of US$1.00 per day was used in
valuing all the lost labour time. This may have led to an
underestimation of the economic burden since the
patients admitted in various hospitals were likely to have
belonged to a wide range of occupations, e.g. peasant
farmers, civil servants, private sector employees, self-
employed (business people), housewives, students,
unemployed, etc. However, the extremes may have been
modified by the fact that we did not adjust the estimated
figures by the rate of unemployment. We were reluctant to
make the adjustment since even those who were voluntar-
ily unemployed attached a lot of value to their leisure
time. In fact, economists have suggested that it would take
double the normal wage rate to induce such people to
trade off their leisure for paid work.
(c) Omission of economic burden imposed by non-institutionalized
MBD patients
Although the current study focussed mainly on an estima-
tion of the economic burden emanating from the institu-
tionalized MBD patients, the same methodology could be
extended to non-institutionalized patients.
The cost of labour time lost per occupational category per
year will be equal to the days of work lost in a typical
month due to MBD, plus the days worked in a typical
month with MBD symptoms, times the per cent produc-
tivity on the days worked with MBD symptoms (assuming
normal productivity is 100%), times the daily earnings for
an individual within an occupational category (4,16).
Algebraically, this can be expressed as follows:
LTC = [MD + (DWS × PRO)] × WR × MO ............... (16)
where: LTC is the cost of the labour time lost by outpatient
MBD patients; MD is the number of the days of work
missed in a typical month due to MBD; DWS is the
number of the days worked in a typical month with MBD
symptoms; PRO is the productivity loss, i.e. 100% minus
the per cent productivity on the days worked with MBD
symptoms; WR is the average daily earnings for an indi-
vidual within an occupational category; and MO is 12
months per year.
(d) Omission of economic costs incurred by MBD patients seeking
care among traditional medicine practitioners
MBD occurrence in the African Region is commonly asso-
ciated with local cultural values and various beliefs
(including religion, magic, ancestral spirits). In this con-
text, majority (although the exact number is unknown) of
MBD patients, particularly in rural areas, seek care from
Annals of General Hospital Psychiatry 2003, 2 http://www.general-hospital-psychiatry.com/content/2/1/7
Page 5 of 7
(page number not for citation purposes)
traditional medicine practitioners, e.g. traditional 'priests'
(diviners and rainmakers), herbalists, magicians, sorcer-
ers. Usually, such patients, majority of whom are poor,
pay the cost of treatment in-kind, e.g. chicken, goats, cere-
als. This study did not estimate the economic cost
incurred by MBD patients that sought care among tradi-
tional medical practitioners.
Results
Table 1 provides an itemized schedule of various costs of
operating and organizing (COO) hospital psychiatric
services during the Kenya Government's financial year
1998/99. The COO amounted to US$10,491,275, out of
which 82.3% constituted recurrent costs and 17.7% capi-
tal costs. Personnel-related expenses, drugs, kitchen (food
and gas), and utilities accounted for 61%, 5%, 7% and 3%
respectively.
Table 2 presents a summary of the direct and indirect
costs. The cost of operating and organizing inpatient psy-
chiatric services in public hospitals amounted to US$10.5
million per year.
The total out-of-pocket expenses (OoPE) borne by
patients and their relatives was US$289,846.
The indirect costs (IC) added up to US$2,569,719.
Ninety-two per cent of the total productivity losses were
attributed to premature mortality and 8% to the time lost
through hospitalization of MBD patients.
The grand total economic loss (i.e. COO plus IC) attribut-
able to the 5,678 admissions due to MBD at various pub-
lic hospitals in Kenya was US$13,350,840.
Discussion
The key findings of this study were:
• The unit cost of operating and organizing psychiatric
services (COO) per admission was US$1848 (i.e.
US$10,491,275 divided by 5,678 inpatients).
• The out-of-pocket expenses (OoPE) borne by patients
and their relatives per admission were US$51 (i.e.
US$289,846 divided by 5,678 inpatients).
• The productivity loss per admission was US$453 (i.e.
US$2,569,719 divided by 5,678 inpatients).
• The direct and indirect costs constituted 81% and 19%
of the total economic burden of MBD.
• The total economic cost of MBD per admission was
US$2,351 (i.e. US$13,350,840 divided by 5,678
inpatients).
The grand total economic cost attributable to the 5,678
MBD admissions at various Kenyan hospitals constituted
approximately 10% of the Ministry of Health's total recur-
rent expenditure in 1998/99. This is an enormous loss in
a country where 50% of the population live on less than
US$1 per day and 56% of the population have no access
to safe drinking water and 15% have no access to ade-
quate sanitation facilities (17).
The readers will recall that 23.2% of total annual health
service expenditure in Netherlands [6]; and 22% of the
annual national health service expenditure in UK [7] goes
to the treatment of mental disorders. Thus, in comparative
terms, the Kenyan estimate of 10% of the Ministry of
Health budget is lower than that of the Netherlands and
Table 1: Annual cost of operating and organizing psychiatric services in Kenya (1 US$ = Ksh. 65 in 1998/99)
Cost items Cost (US$) Percentage
Personnel salaries 4,837,527 46.11
Fringe benefits 1,569,495 14.96
Transport operating expenses 39,867 0.38
Travel expenses 26,228 0.25
Utilities 281,166 2.68
Hospital boards, committees & conferences 17,835 0.17
Drugs 568,627 5.42
Food & cooking gas 750,126 7.15
Non-pharmaceutical supplies 118,551 1.13
Materials 257,036 2.45
Maintenance 91,274 0.87
Rents and rates 77,635 0.74
Annual capital cost 1,855,907 17.69
TOTAL COST 10,491,275 100
Annals of General Hospital Psychiatry 2003, 2 http://www.general-hospital-psychiatry.com/content/2/1/7
Page 6 of 7
(page number not for citation purposes)
the UK. This difference could be attributed to two factors.
Firstly, there is evidence that many of MBD patients in
Kenya go largely unrecognized and/or wrongly diagnosed
and receiving inappropriate treatment in the non-psychi-
atric health facilities [9]. Secondly, the current study omit-
ted the economic burden imposed by non-
institutionalized MBD patients who are treated in health
centres, public hospitals outpatient departments, profit
and not-for-profit private hospitals and traditional medi-
cal practitioners clinics.
Conclusion
This study, in spite of its limited scope, has demonstrated
that MBD imposes a substantive economic cost on the
country. And, although the current study focussed mainly
on an estimation of the economic burden emanating
from the institutionalized MBD patients, it has demon-
strated how the same methodology could be extended to
non-institutionalized patients.
Given the high degree of ignorance about the magnitude
of the epidemiological and economic burdens of MBD in
sub-Saharan Africa, there is an urgent need for research to
determine:
• national-level epidemiological burden of MBD, meas-
ured in terms of its prevalence, incidence, mortality and,
probably, disability-adjusted life-years lost;
• national-level economic burden of MBD, broken down
by different productive and social sectors and occupations
of patients and relatives; and
• costs and consequences of alternative treatments, pre-
vention of MBD and promotion of mental health to facil-
itate use of more cost-effective strategies and informed
choice of interventions.
• proportion of MBD patients seeking care from tradi-
tional medicine practitioners and the reasons for such a
choice of source of care.
Competing interests
None declared.
Authors' contributions
JMK entered the data, participated in the methodology
development, analysis and drafting of sections of the doc-
ument. LGS participated in the development of the meth-
odology, drafting of sections of the manuscript and
coordination of the entire study.
Appendix: assumptions
The assumptions presented below are based on studies
undertaken in Kenya [9,14].
Assumptions related to patients from within the district where
the hospital is situated:
A. 60% of inpatient admissions are from the district where
a hospital is situated;
B. each patient is accompanied by two adults when being
taken for admission;
C. each patient will, on average, spend 29.9 days in the
hospital;
D. each patient and the two accompanying adults will
spend a total of 8 hours each, i.e. including seeking
doctor's/magistrate's recommendation for admission,
travel time and waiting for admission. During the visit a
total of US$9 will be spent on lunch (i.e. US$3 per
person);
E. each patient will have a one-day visit by two relatives /
friends during the length of his/her stay. During the visit
a total of US$9 will be spent on lunch (i.e. US$3 per
person);
F. return journey public transport fare is US$0.77 per per-
son; and
Table 2: Direct and indirect costs of MBD (1 US$ = Ksh. 65 in 1998/99)
Cost components Cost (US$) Percentage
Direct costs:
(1). Total cost of operating and organizing psychiatric services 10,491,275 78.6
(2) Out-of-pocket expenses borne by patients and family members 289,846 2.2
Indirect costs:
(1) Value of productivity lost by patients and family members due to MBD morbidity 203,840 1.5
(2) Value of productivity lost through premature mortality of MBD patients 2,365,879 17.7
TOTAL COST 13,350,840 100.00
Publish with BioMed Central and every
scientist can read your work free of charge
"BioMed Central will be the most significant development for
disseminating the results of biomedical research in our lifetime."
Sir Paul Nurse, Cancer Research UK
Your research papers will be:
available free of charge to the entire biomedical community
peer reviewed and published immediately upon acceptance
cited in PubMed and archived on PubMed Central
yours — you keep the copyright
Submit your manuscript here:
http://www.biomedcentral.com/info/publishing_adv.asp
BioMedcentral
Annals of General Hospital Psychiatry 2003, 2 http://www.general-hospital-psychiatry.com/content/2/1/7
Page 7 of 7
(page number not for citation purposes)
G. wage rate per hour is US$0.125 per hour.
Assumptions related to patients admitted from other districts:
A. 40% of inpatient admissions are from other districts;
B. each patient is accompanied by two adults when being
taken for admission;
C. each patient will, on average, spend 29.9 days in the
hospital;
D. each patient and the two accompanying adults will
spend a total of 16 hours each, i.e. including seeking doc-
tor's/magistrate's recommendation for admission, travel
time and waiting for admission;
E. the two accompanying relatives will spend a night in
the town where the hospital is located. Thus, each will
incur a hotel accommodation and breakfast cost of US$8,
lunch cost of US$3, and dinner cost of US$3;
F. each patient will have a one-day visit by two relatives /
friends during the length of his/her stay;
G. return journey public transport fare is US$7.7 per per-
son; and
H. wage rate per hour is US$0.125 per hour.
Assumption related to the MBD patients
We are assuming that all the 5678 cases reported in this
study fall within the mental and behavioural disorders
defined in ICD10 [18].
Acknowledgements
The multi-faceted assistance provided by Jehovah Nissi, Wilson Liambila,
Fidelis Morfaw and A.S. Kochar is greatly appreciated. The authors alone
are responsible for the views expressed in this publication.
References
1. Goddard PC: Fifty-fourth World Health Assembly: Report
from the ministerial round tables Geneva: WHO 2001.
2. WHO: Ministerial round tables: Mental health. Fifty-fourth
World Health Assembly – provisional agenda item 10 Geneva
2001.
3. WHO: The World Health Report 2000 Geneva 2000.
4. Osterhaus JT, Gutterman DL and Plachetka JR: Health care
resource and lost labour costs of migraine in the US Pharmaco-
Economics 1992, 2:67-76.
5. Rice DP, Kelman S and Miller LS: Estimates of economic costs of
alcohol and drug abuse and MBD, 1985 and 1988 Public Health
Reports 1991, 106(3):280-292.
6. Meerding WJ, Bonneux L, Polder JJ, Koopmanschap MA and Maas PJ:
Demographic and epidemiological determinants of health
care costs in the Netherlands: cost of illness study British Med-
ical Journal 1998, 317:111-115.
7. Patel A and Knapp MRJ: Costs of MBD in England Mental Health
Research Review 1998, 5:4-10.
8. WHO: The World Health Report 2001. Mental Health: New
Understanding, New Hope Geneva 2001.
9. John Snow Inc: Nairobi area health services study Washington
1988.
10. Ministry of Health: Health Information Systems Nairobi 2000.
11. Kenya Government: Estimates of recurrent expenditure of the
Government of Kenya for the year ending 30
th
June, 2000 Nai-
robi 1999.
12. Kirigia JM, Snow RW, Fox-Rushby J and Mills A: The cost of treat-
ing paediatric malaria admissions and the potential impact
of insecticide-treated mosquito nets on hospital expenditure
Tropical Medicine and International Health 1998, 3(2):145-150.
13. Kirigia JM, Fox-Rushby J and Mills A: A cost analysis of Kilifi and
Malindi public hospitals in Kenya African Journal of Health Sciences
1998, 5(2):79-84.
14. Kirigia JM: Cost-utility of schistosomiasis intervention strate-
gies in Kenya Environment and Development Economics 1998, 3:319-
346.
15. Kirigia JM, Sambo LG and Kainyu LH: Willingness-to-pay for schis-
tosomiasis-related outcomes in Kenya African Journal of Health
Sciences 2000, 7(55-65):3-4.
16. Legg RF, Sclar DA, Nemec NL, Tarnai J and Mackowiak JI: Cost-ben-
efit of Sumatriptan to an employer Journal of Occupational and
Environmental Medicine 1997, 39(7):652-657.
17. UNDP: Human development report 2000 Oxford: Oxford Univer-
sity Press 2000.
18. WHO: International statistical classification of diseases and
related health problems Geneva 1992.
... Drug compliance in patients with schizophrenia is predicted by the patients' attitude towards medications [6,7]. Negative attitude towards antipsychotic medication is common in clinical practice with the prevalence ranges from 7.5%-46.7% ...
... Up to 75% of those with a negative attitude have non-adherence to antipsychotic drugs, 2 Schizophrenia Research and Treatment which results in a relapse. The prevalence of relapse due to non-adherence varies from 50% to 92% globally [6,12]. Patients with schizophrenia are most likely to die early from potentially treatable conditions as a result of nonadherence to prescribed medications [13][14][15]. ...
... In our clinical observations, many schizophrenic patients discontinue their prescribed medications and re-hospitalized due to relapse of the illness, which result in a high cost for a health care system. Different studies [6,12] have showed that more than half of patients with schizophrenia have nonadhere to antipsychotic drugs due to their negative attitude towards the medication. Even though attitude has an impact on antipsychotic medication compliance, there is no study showing attitude of patients diagnosed with schizophrenia towards antipsychotic medication in Ethiopia. ...
Article
Full-text available
Background: Poor attitude towards antipsychotic drugs is high, and it is a factor for non-adherence to treatment. This increases the risk of relapse, associated healthcare utilization, and costs. This study aimed to assess attitude towards antipsychotic medication among patients with schizophrenia. Objectives: The aim of this institution based cross-sectional study was to assess attitude towards antipsychotic medications and associated factors among patients with schizophrenia who attend the outpatient clinics at Amanuel Mental Specialized Hospital, 2018. Methods: In a cross-sectional study, 393 schizophrenic patients from Amanuel Mental Specialized Hospital were recruited by a systematic random sampling technique. Drug Attitude Inventory (DAI-10) was used to assess attitude, experience, and belief about antipsychotics. Glasgow antipsychotic side effect scale modified version, positive and negative syndrome scale, and Birch wood's insight scale for psychosis were the instruments used to assess the associated factors. Simple and multiple linear regression analysis models were fitted, and the adjusted unstandardized beta (β) coefficient at 95% confidence interval was used. Results: The mean score of attitude towards antipsychotic medications was 6.51 with standard deviation (SD) of 2.22. In multiple linear regression, positive symptoms (β= -0.07, 95% CI: (-0.09, -0.05)), negative symptoms (β= -0.04, 95% CI: (-0.06,-0.02)), shorter (≤5 years) duration of illness (β= -0.39, 95% CI: (-0.63, -0.15)), first generation antipsychotics (β = -0.35, 95% CI: (-0.55,-0.14)), having sedation (β= -0.28, 95% CI: (-0.52, -0.02)), and extra-pyramidal side effects (β= -0.34, 95% CI: (-0.59,-0.09)) were factors negatively associated with attitude towards antipsychotic medication treatment. Insight to illness (β= 0.24, 95% CI: (0.20, 0.27) was a factor positively associated with attitude towards antipsychotic medications. Conclusion: The result suggests that the mean score of participants' attitude towards antipsychotic medications was good. Prevention of side effects particularly due to first generation antipsychotics is necessary.
... [2][3][4] Poor medication adherence is associated with frequent relapses, recurrence of symptoms, [5,6] increase in overall treatment costs and caregiver burden, [7,8] increased rate of rehospitalization, frequent emergency visits, poor quality of life, and overall increased morbidity. [9][10][11][12][13][14][15][16][17] Medication adherence is influenced by many factors. Most of the available literature which have evaluated the risk factors for poor medication adherence has focused on the demographic, clinical, and treatment-related factors. ...
... [11][12][13][14] Available data suggest that about 75% of patients with negative attitude have poor adherence with the psychotropics. [9][10][11][12][13][14][15][16] Attitude toward medications is influenced by demographic, clinical, and other (personal/cultural) factors. The demographic factors which are shown associated with a negative attitude toward medications include younger age, single, male gender, unemployment, lower level of education, and belonging to urban locality. ...
Article
Full-text available
Background: Attitude toward psychotropic medications influences medication adherence. Although there are some data on attitude toward psychotropics among the adult patients, there is a lack of data on attitude of elderly patients toward psychotropic medications. Aim: The study aimed to evaluate the attitude of elderly patients toward psychotropic medications and compare the same with adult patients. Materials and Methodology: Attitude toward psychotropic medications of 102 elderly patients and 499 adult patients diagnosed with affective or psychotic disorders were compared using self-report attitude toward psychotropic medications questionnaire. Results: Compared to adult participants, higher proportion of elderly patients considered psychotropic medications to be the most effective way to treat mental illness and believed that psychotropics are a better option for treatment of mental illnesses than alternative treatments. Compared to adults, significantly lower proportion of the elderly believed that psychotropics do not cure but can lead to substantial improvement. In terms of negative attitude toward psychotropic medications, compared to adult participants, significantly higher proportion of the elderly believed that psychotropics are unnatural and poisonous substances which are harmful; psychotropics are just sedatives, which only calm down the patients; in long-run psychotropics worsen the illness; psychotropics can make the body unnaturally hot or cold; are expensive; make the subjects weak and enervated, and it is always better to take less than the prescribed dose of these medications. Compared to adults, elderly patients had significantly higher negative attitude subscale score. Conclusion: Compared to adult patients with affective and psychotic disorders, elderly patients have more negative attitude toward psychotropic medications. Hence, clinicians managing elderly patients should always evaluate the negative attitudes of the elderly toward psychotropic medications and try to address the same, to improve the medication adherence and outcome.
... Los costos económicos de los trastornos mentales incluyen los de organizar y operar servicios de salud mental, el impacto en los recursos de familiares y cuidadores, y la poca productividad laboral por incapacidades, morbilidad y mortalidad temprana (23). En el Foro Económico Mundial se estimó que el costo económico global de los trastornos mentales excede los de cualquiera de las principales enfermedades no trasmisibles, como diabetes, enfermedades cardiovasculares, enfermedades respiratorias crónicas y cáncer (24). ...
... En un estudio realizado en cinco países europeos, se concluyó que los costos indirectos producidos por los trastornos mentales equivalen al 4 % del producto interno bruto, dos tercios debido a la falta de productividad y un tercio por incapacidades (4). En otro estudio se demostró que el 92 % de la pérdida total de productividad fue atribuida a mortalidad prematura y, el 8 % a tiempo que se pierde durante la hospitalización (23). ...
Article
Full-text available
Los trastornos mentales son prevalentes en todo el mundo y constituyen un problema de salud pública, por su frecuencia y consecuencias a nivel personal, familiar y social. Los problemas mentales afectan, no solo la calidad de vida de quienes los padecen, sino también, la de sus cuidadores y familiares. Además, los costos directos e indirectos que genera la atención de estos problemas consumen gran parte de los recursos de los países, principalmente de aquellos de bajos y medianos ingresos. A pesar del gran número de personas que sufren de algún problema de salud mental, solo un pequeño porcentaje recibe los tratamientos mínimos necesarios para superar estas condiciones. Se han propuesto múltiples alternativas que permitan cerrar esta brecha. La Organización Mundial de la Salud (OMS) ha insistido en la necesidad de integrar la salud mental a los servicios de atención primaria en salud, para garantizar un mejor cuidado de quienes sufren problemas de la esfera mental. Esto implica superar los roles tradicionales que se han asignado a los psiquiatras y a otros trabajadores del área de la salud mental, y replantear su aporte al sistema de salud.
... Los costos económicos de los trastornos mentales incluyen los de organizar y operar servicios de salud mental, el impacto en los recursos de familiares y cuidadores, y la poca productividad laboral por incapacidades, morbilidad y mortalidad temprana (23). En el Foro Económico Mundial se estimó que el costo económico global de los trastornos mentales excede los de cualquiera de las principales enfermedades no trasmisibles, como diabetes, enfermedades cardiovasculares, enfermedades respiratorias crónicas y cáncer (24). ...
... En un estudio realizado en cinco países europeos, se concluyó que los costos indirectos producidos por los trastornos mentales equivalen al 4 % del producto interno bruto, dos tercios debido a la falta de productividad y un tercio por incapacidades (4). En otro estudio se demostró que el 92 % de la pérdida total de productividad fue atribuida a mortalidad prematura y, el 8 % a tiempo que se pierde durante la hospitalización (23). ...
Article
Full-text available
Resumen Los trastornos mentales son prevalentes en todo el mundo y constituyen un problema de salud pública, por su frecuencia y consecuencias a nivel personal, familiar y social. Los problemas mentales afectan, no solo la calidad de vida de quienes los padecen, sino también, la de sus cuidadores y familiares. Además, los costos directos e indirectos que genera la atención de estos problemas consumen gran parte de los recursos de los países, principalmente de aquellos de bajos y medianos ingresos. A pesar del gran número de personas que sufren de algún problema de salud mental, solo un pequeño porcentaje recibe los tratamientos mínimos necesarios para superar estas condiciones. Se han propuesto múltiples alternativas que permitan cerrar esta brecha. La Organización Mundial de la Salud (OMS) ha insistido en la necesidad de integrar la salud mental a los servicios de atención primaria en salud, para garantizar un mejor cuidado de quienes sufren problemas de la esfera mental. Esto implica superar los roles tradicionales que se han asignado a los psiquiatras y a otros trabajadores del área de la salud mental, y replantear su aporte al sistema de salud. Palabras clave: salud mental, prevalencia, atención primaria.
... A study in Kenya for instance estimated that the total costs per patient for 5,678 individuals with mental health problems hospitalised in 1999 were US$ 2,351. The total economic costs for this group alone were more than US$ 13.3 million, equivalent to 10% of the Ministry of Health's budget (Kirigia & Sambo, 2003). ...
Technical Report
Full-text available
Background: Substantial proportion of the world’s disease burden came from mental, neurological and substance use disorders. This study evaluates the benefit-cost of interventions targeting screening and treatment of depression, anxiety disorders and schizophrenia. Method: We estimated the cost and benefits of providing screening and treatment to an estimated proportion of the population based on the average disease prevalence rate from 1990 to 2017. Each analysis focuses on a single cohort, first screened in 2019 and followed for 10 years.Results: The undiscounted cost of depression, anxiety disorder and schizophrenia were GHS110m; GHS108m; and GHS36mrespectively. The estimated BCRs were around 7.44 for depression, 4.94 for anxiety disorder and 1.66 for schizophrenia at 5% discount rate. All three interventions had positive net-present values (NPVs) and >1 BCRs indicating the benefits from all programs are higher than their respective costs. Conclusion: The findings strongly reinforce the enormous economic benefits of mental health interventions and the urgent need of governments to invest in mental health interventions.
Article
Full-text available
ABSTRACT This study bridges extant information gap on the pecuniary value of disability-adjusted-life-years (DALYs) lost in the Arab Maghreb Union (AMU). The DALYs lost in 2015 are converted into money using human capital (lost output) approach. The AMU total value of DALYs lost from all causes is the sum of each of the five country’s pecuniary value of DALYs (PVD) lost from all causes. The PVD associated with DALYs lost due to jth disease among persons of a specific age group is the product of the per capita non-health GDP in international dollars (Int$) and the total DALYs lost. The 27,175,610 DALYs lost in AMU in 2015 had a pecuniary value of Int$ 289,033,271,814, which is equivalent to 25.6% the sub-region’s 2015 GDP. The average pecuniary value per DALY lost was Int$ 10,636, which ranged from a minimum of Int$ 4226 in Mauritania to a maximum of Int$ 13,852 in Algeria. The pecuniary value of DALYs lost from all causes in the AMU sub-region annually is substantive. KEYWORDS: Disability-Adjusted-Life-Year (DALY), Pecuniary Value of DALY, Gross Domestic Product, Arab Maghreb Union
Article
Full-text available
The high prevalence of alcohol and drug abuse and mental illness imposes a substantial financial burden on those affected and on society. The authors present estimates of the economic costs from these causes for 1985 and 1988, based on current and reliable data available from national surveys and the use of new costing methodology. The total losses to the economy related to alcohol and drug abuse and mental illness for 1988 are estimated at $273.3 billion. The estimate includes $85.8 billion for alcohol abuse, $58.3 billion for drug abuse, and $129.3 billion for mental illness. The total estimated costs for 1985, $218.1 billion, include $51.4 billion for direct treatment and support costs; $80.8 billion for morbidity costs, the value of reduced or lost productivity; $35.8 billion for mortality costs, the value of foregone future productivity for the 140,593 premature deaths associated with these disorders, based on a 6 percent discount rate and including an imputed value for housekeeping services; and $47.5 billion in other related costs, including the costs of crime, motor vehicle crashes, fire destruction, and the value of productivity losses for victims of crime, incarceration, crime careers, and caregiver services. The cost of acquired immunodeficiency syndrome associated with drug abuse is estimated at $1 billion, and the cost of fetal alcohol syndrome is estimated at $1.6 billion. The estimates may be considered lower limits of the true costs to society of alcohol and drug abuse and mental illness in the United States.
Article
Full-text available
To determine the demands on healthcare resources caused by different types of illnesses and variation with age and sex. Information on healthcare use was obtained from all 22 healthcare sectors in the Netherlands. Most important sectors (hospitals, nursing homes, inpatient psychiatric care, institutions for mentally disabled people) have national registries. Total expenditures for each sector were subdivided into 21 age groups, sex, and 34 diagnostic groups. Netherlands, 1994. Proportion of healthcare budget spent on each category of disease and cost of health care per person at various ages. After the first year of life, costs per person for children were lowest. Costs rose slowly throughout adult life and increased exponentially from age 50 onwards till the oldest age group (> or = 95). The top five areas of healthcare costs were mental retardation, musculoskeletal disease (predominantly joint disease and dorsopathy), dementia, a heterogeneous group of other mental disorders, and ill defined conditions. Stroke, all cancers combined, and coronary heart disease ranked 7, 8, and 10, respectively. The main determinants of healthcare use in the Netherlands are old age and disabling conditions, particularly mental disability. A large share of the healthcare budget is spent on long term nursing care, and this cost will inevitably increase further in an ageing population. Non-specific cost containment measures may endanger the quality of care for old and mentally disabled people.
Article
This article provides surgical pathologists an overview of health information systems (HISs): what they are, what they do, and how such systems relate to the practice of surgical pathology. Much of this article is dedicated to the electronic medical record. Information, in how it is captured, transmitted, and conveyed, drives the effectiveness of such electronic medical record functionalities. So critical is information from pathology in integrated clinical care that surgical pathologists are becoming gatekeepers of not only tissue but also information. Better understanding of HISs can empower surgical pathologists to become stakeholders who have an impact on the future direction of quality integrated clinical care. Copyright © 2015 Elsevier Inc. All rights reserved.
Article
To calculate the costs at Kilifi District Hospital (KDH) and Malindi Sub-district Hospital (MSH) of treating paediatric malaria admissions including three common presentations of severe paediatric malaria, i.e. cerebral malaria, severe malaria anaemia and malaria-associated seizures; and to estimate the implications for hospital expenditure of a reduction in paediatric malaria admissions. Patient data were obtained from hospital records. All costs were allocated to departments that provided direct patient care by a four-stage step-down procedure. Laboratory and drug costs of treating paediatric malaria admissions were separately identified. Unit recurrent costs per admission in KDH ranged from US $57 for 'other' paediatric malaria to US $105 for cerebral malaria, and in MSH from US $33 to US $44 for the same categories. The annual recurrent cost of treating all paediatric malaria admissions to KDH prior to the trial was estimated at US $78 900. Adjusting for preintervention differences in malaria admission rates and age between intervention and control areas, the ITBN trial found a 41% reduction in paediatric malaria admissions. The reduction in admissions resulted in an estimated saving of US $6240 in the cost of treating paediatric malaria admissions from the intervention area. There would be a substantial reduction in costs of treating paediatric malaria admissions if the intervention were introduced in the whole catchment area of the hospital. Actual savings would depend on the proportion of potential savings that can in practice be realised, and on the effectiveness of the intervention when routinely implemented.
Article
Benefit and occupational health managers need information on whether new treatments, such as sumatriptan, for migraine headache improve organizational or individual performance. A work productivity outcomes assessment was conducted among sumatriptan-using employees of an Independent Practice Association-health maintenance organization population. Of the 164 sumatriptan users, 101 full-time employees were surveyed by telephone once in an open-label, before-after design. The results revealed that lost labor costs, a function of days missed from work and reduced productivity at work as a result of migraine, were decreased after sumatriptan treatment initiation. Incremental benefit of this reduction in lost productivity is valued at $435/month per employee. The sumatriptan cost associated with this benefit is $43.78/month. The benefit-to-cost ratio is 10:1. Other costs and benefits were excluded. In conclusion, the availability of sumatriptan for migraine headache treatments in this IPA-HMO resulted in improved work productivity and had a net benefit for the employer.
Article
Migraine headache is responsible for significantly more healthcare resource and lost labour costs than previously reported. Costs associated with migraine were assessed via a survey conducted in 940 patients, 70% of whom responded. All met the International Headache Society's diagnostic criteria for migraine and had participated in one of two multicentre, single-dose, parallel-group, randomised, placebo-controlled clinical trials designed to assess the efficacy of an anti-migraine compound. Migraine frequency and costs, in terms of healthcare resource utilisation and lost labour (decreased productivity and missed workdays), were assessed. Over 90% of respondents visited a clinic and nearly 50% presented to an emergency room for treatment of migraine-related symptoms at least once in the year prior to the survey. These 648 respondents used an estimated $US529 199 per year in healthcare services. 89% of employed respondents reported that job performance was adversely affected by migraine and over 50% of them missed at least two days of work per month. Depending on the estimates used for migraine prevalence and using 1986 estimates of median earnings for the US work force, the extrapolated costs to employers ranged from $US5.6 billion to $US17.2 billion dollars annually due to decreased productivity and missed work days. The cost of migraine is not fully appreciated by the medical community or by society.