Mangalore Roshni, Knapp Martin
PSSRU, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK.
J Ment Health Policy Econ. 2007 Mar;10(1):23-41.
Despite the wide-ranging financial and social burdens associated with schizophrenia, there have been few cost-of-illness studies of this illness in the UK.
To provide up-to-date, prevalence based estimate of all costs associated with schizophrenia for England.
A bottom-up approach was adopted. Separate cost estimates were made for people living in private households, institutions, prisons and for those who are homeless. The costs included related to: health and social care, informal care, private expenditures, lost productivity, premature mortality, criminal justice services and other public expenditures such as those by the social security system. Data came from many sources, including the UK-SCAP (Schizophrenia Care and Assessment Program) survey, Psychiatric Morbidity Surveys, Department of Health and government publications.
The estimated total societal cost of schizophrenia was 6.7 billion pounds in 2004/05. The direct cost of treatment and care that falls on the public purse was about 2 billion pounds; the burden of indirect costs to the society was huge, amounting to nearly 4.7 billion pounds. Cost of informal care and private expenditures borne by families was 615 million pounds. The cost of lost productivity due to unemployment, absence from work and premature mortality of patients was 3.4 billion pounds. The cost of lost productivity of carers was 32 million pounds. Estimated cost to the criminal justice system was about 1 million pounds. It is estimated that about 570 million pounds will be paid out in benefit payments and the cost of administration associated with this is about 14 million pounds.
It is difficult to compare estimates from previous cost-of-illness studies due to differences in the methods, scope of analyses and the range of costs covered. Costs estimated in this study are detailed, cover a comprehensive list of relevant items and allow for different levels of disaggregation. The main limitation of the study is that data came from a variety of secondary sources and some official data publicly available was not the latest.
Schizophrenia continues to be a high cost illness because of the range of health needs that people have. Despite the shifting balance of care away from hospital-based care, the health care costs of treating and supporting people with schizophrenia remain high.
Decision-makers need to recognise the breadth of economic impacts, well beyond the health system as conventionally defined. For example, as nearly 80% of schizophrenia patients remain unemployed, the cost of lost productivity is especially large.
Better measurement of criminal justice services costs, private expenditures borne by families and valuation of lost quality of life could improve the estimates further.
尽管精神分裂症会带来广泛的经济和社会负担，但在英国，针对这种疾病的疾病成本研究却很少。
提供基于患病率的英格兰精神分裂症相关所有成本的最新估计。
采用自下而上的方法。分别对居住在私人家庭、机构、监狱中的人群以及无家可归者的成本进行了估计。成本包括与以下方面相关的费用：医疗和社会护理、非正式护理、私人支出、生产力损失、过早死亡、刑事司法服务以及其他公共支出，如社会保障系统的支出。数据来自多个来源，包括英国精神分裂症护理与评估项目（UK - SCAP）调查、精神疾病患病率调查、卫生部和政府出版物。
2004/05年度，精神分裂症的社会总成本估计为67亿英镑。公共财政承担的治疗和护理直接成本约为20亿英镑；社会间接成本负担巨大，接近47亿英镑。家庭承担的非正式护理和私人支出成本为6.15亿英镑。患者因失业、缺勤和过早死亡导致的生产力损失成本为34亿英镑。护理人员的生产力损失成本为3200万英镑。刑事司法系统的估计成本约为100万英镑。估计将支付约5.7亿英镑的福利金，与此相关的管理成本约为1400万英镑。
由于方法、分析范围和涵盖的成本范围不同，很难将本研究的估计结果与以往疾病成本研究的结果进行比较。本研究估计的成本详细，涵盖了相关项目的完整清单，并允许进行不同程度的细分。该研究的主要局限性在于数据来自各种二手来源，一些公开可用的官方数据不是最新数据。
由于人们有各种各样的健康需求，精神分裂症仍然是一种高成本疾病。尽管护理平衡已从以医院为基础的护理转向其他方式，但治疗和支持精神分裂症患者的医疗保健成本仍然很高。
决策者需要认识到经济影响的广度，远远超出传统定义的卫生系统。例如，由于近80%的精神分裂症患者仍未就业，生产力损失成本尤其巨大。
更好地衡量刑事司法服务成本、家庭承担的私人支出以及对生活质量损失的估值，可以进一步改进估计结果。
