Wu Eric Q, Birnbaum Howard G, Shi Lizheng, Ball Daniel E, Kessler Ronald C, Moulis Matthew, Aggarwal Jyoti
Analysis Group, Inc., Boston, MA 02199, USA.
J Clin Psychiatry. 2005 Sep;66(9):1122-9. doi: 10.4088/jcp.v66n0906.
This study quantifies excess annual costs associated with schizophrenia patients in the United States in 2002 from a societal perspective.
Annual direct medical costs associated with schizophrenia were estimated separately for privately (N = 1090) and publicly (Medicaid; N = 14,074) insured patients based on administrative claims data, including a large private claims database and the California Medicaid program (MediCal) database, and compared separately to demographically/geographically matched control samples (1 case:3 controls). Medicare costs of patients over age 65 years were imputed using the Medicare/MediCal dual-eligible patients (N = 1491) and published statistics. Excess annual direct non-health care costs were estimated for law enforcement, homeless shelters, and research/training related to schizophrenia. Excess annual indirect costs were estimated for 4 components of productivity loss: unemployment, reduced workplace productivity, premature mortality from suicide, and family caregiving using a human capital approach based on market wages. All costs were adjusted to 2002 dollars using the Medical Care Consumer Price Index and were based on the reported prevalence in the National Comorbidity Survey Replication.
The overall U.S. 2002 cost of schizophrenia was estimated to be $62.7 billion, with $22.7 billion excess direct health care cost ($7.0 billion outpatient, $5.0 billion drugs, $2.8 billion inpatient, $8.0 billion long-term care). The total direct non-health care excess costs, including living cost offsets, were estimated to be $7.6 billion. The total indirect excess costs were estimated to be $32.4 billion.
Schizophrenia is a debilitating illness resulting in significant costs. The indirect excess cost due to unemployment is the largest component of overall schizophrenia excess annual costs.
本研究从社会角度对2002年美国精神分裂症患者的年度额外费用进行量化。
基于行政索赔数据，分别对私人保险患者（N = 1090）和公共保险患者（医疗补助；N = 14,074）与精神分裂症相关的年度直接医疗费用进行估算，行政索赔数据包括一个大型私人索赔数据库和加利福尼亚医疗补助计划（MediCal）数据库，并分别与人口统计学/地理匹配的对照样本（1例患者：3名对照）进行比较。65岁以上患者的医疗保险费用通过医疗保险/医疗补助双重资格患者（N = 1491）及已公布的统计数据进行估算。估算了与精神分裂症相关的执法、无家可归者收容所以及研究/培训方面的年度额外直接非医疗费用。采用基于市场工资的人力资本方法，对生产力损失的4个组成部分（失业、工作场所生产力下降、自杀导致的过早死亡以及家庭护理）的年度间接费用进行估算。所有费用均使用医疗保健消费者价格指数调整为2002年美元，并基于全国共病调查复制版中的报告患病率。
2002年美国精神分裂症的总体费用估计为627亿美元，其中直接医疗额外费用为227亿美元（门诊70亿美元、药品50亿美元、住院28亿美元、长期护理80亿美元）。包括生活成本抵消在内的直接非医疗额外费用总计估计为76亿美元。间接额外费用总计估计为324亿美元。
精神分裂症是一种使人衰弱的疾病，会导致巨大费用。失业导致的间接额外费用是精神分裂症年度总体额外费用的最大组成部分。
