1Hobart and Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia.
Aust N Z J Psychiatry. 2014 Feb;48(2):169-82. doi: 10.1177/0004867413500352. Epub 2013 Oct 4.
To estimate the annual costs of psychosis in Australia from societal and government perspectives and assess whether average costs per person differ by principal service provider at time of census.
Costs of psychosis encompassing health sector costs, other sector costs, and productivity losses were assessed for 2010 using a prevalence-based, bottom-up approach. Resource use data were obtained from the second Australian National Survey of Psychosis and unit costs were from government and non-government organization (NGO) sources. Costs to society were assessed by principal service provider at census: public specialized mental health services (PSMHS) and NGOs during the census month (current clients), and PSMHS in the 11 months preceding census (recent clients), and any differences were ascertained.
The average annual costs of psychosis to society are estimated at $77,297 per affected individual, comprising $40,941 in lost productivity, $21,714 in health sector costs, and $14,642 in other sector costs. Health sector costs are 3.9-times higher than those for the average Australian. Psychosis costs Australian society $4.91 billion per annum, and the Australian government almost $3.52 billion per annum. There are significant differences between principal service providers for each cost category. Current PSMHS clients had the highest health sector costs overall, and the highest mental health ambulatory, inpatient, and antipsychotic medication costs specifically. NGO clients had the highest other sector costs overall and the highest NGO assistance, supported employment, and supported accommodation costs. Recent PSMHS clients had the lowest productivity losses for reduced participation and the highest costs for absenteeism and presenteeism.
The costs of psychosis are broad ranging and very high. Development and implementation of cost-effective prevention, treatment, and support strategies is critical to maximizing the efficiency of service delivery. A needs-based framework based on principal service provider and recency of contact may facilitate this process.
从社会和政府角度估算澳大利亚精神病的年度成本，并评估在普查时主要服务提供者的人均成本是否存在差异。
采用基于患病率的自下而上方法，于 2010 年评估精神病的卫生部门成本、其他部门成本和生产力损失成本。从第二次澳大利亚全国精神病普查获得资源使用数据，从政府和非政府组织（NGO）获得单位成本数据。根据普查时的主要服务提供者评估社会成本：普查当月的公共专门精神卫生服务（PSMHS）和 NGO（当前客户），以及普查前 11 个月的 PSMHS（近期客户），并确定任何差异。
社会上受精神病影响的个体的年平均成本估计为 77297 澳元，其中包括 40941 澳元的生产力损失、21714 澳元的卫生部门成本和 14642 澳元的其他部门成本。卫生部门成本是普通澳大利亚人的 3.9 倍。精神病每年给澳大利亚社会造成 49.1 亿澳元的损失，澳大利亚政府每年损失近 35.2 亿澳元。每个成本类别的主要服务提供者之间存在显著差异。目前的 PSMHS 客户的整体卫生部门成本最高，特别是精神病门诊、住院和抗精神病药物治疗的费用最高。NGO 客户的其他部门成本最高，特别是 NGO 援助、支持性就业和支持性住宿的费用最高。最近的 PSMHS 客户因减少参与导致的生产力损失最低，旷工和出勤的成本最高。
精神病的成本广泛且非常高。制定和实施具有成本效益的预防、治疗和支持策略对于最大限度地提高服务提供效率至关重要。以主要服务提供者和最近接触为基础的需求导向框架可能有助于这一过程。
