Cloutier Martin, Aigbogun Myrlene Sanon, Guerin Annie, Nitulescu Roy, Ramanakumar Agnihotram V, Kamat Siddhesh A, DeLucia Michael, Duffy Ruth, Legacy Susan N, Henderson Crystal, Francois Clement, Wu Eric
Analysis Group, Montreal, Quebec, Canada.
Otsuka America Pharmaceutical, 508 Carnegie Center, Princeton, NJ 08540.
J Clin Psychiatry. 2016 Jun;77(6):764-71. doi: 10.4088/JCP.15m10278.
The objective of this study was to estimate the US societal economic burden of schizophrenia and update the 2002 reported costs of $62.7 billion given the disease management and health care structural changes of the last decade.
A prevalence-based approach was used to assess direct health care costs, direct non-health care costs, and indirect costs associated with schizophrenia (ICD-9 codes 295.xx) for 2013, with cost adjustments where necessary. Direct health care costs were estimated using a retrospective matched cohort design using the Truven Health Analytics MarketScan Commercial Claims and Encounters, Medicare Supplemental, and Medicaid Multistate databases. Direct non-health care costs were estimated for law enforcement, homeless shelters, and research and training. Indirect costs were estimated for productivity loss from unemployment, reduced work productivity among the employed, premature mortality (ie, suicide), and caregiving.
The economic burden of schizophrenia was estimated at $155.7 billion ($134.4 billion-$174.3 billion based on sensitivity analyses) for 2013 and included excess direct health care costs of $37.7 billion (24%), direct non-health care costs of $9.3 billion (6%), and indirect costs of $117.3 billion (76%) compared to individuals without schizophrenia. The largest components were excess costs associated with unemployment (38%), productivity loss due to caregiving (34%), and direct health care costs (24%).
Schizophrenia is associated with a significant economic burden where, in addition to direct health care costs, indirect and non-health care costs are strong contributors, suggesting that therapies should aim at improving not only symptom control but also cognition and functional performance, which are associated with substantial non-health care and indirect costs.
本研究的目的是估计美国精神分裂症的社会经济负担，并鉴于过去十年疾病管理和医疗保健结构的变化，更新2002年报告的627亿美元成本。
采用基于患病率的方法评估2013年与精神分裂症（国际疾病分类第九版编码295.xx）相关的直接医疗保健成本、直接非医疗保健成本和间接成本，并在必要时进行成本调整。直接医疗保健成本使用回顾性匹配队列设计，利用Truven Health Analytics MarketScan商业索赔与病历、医疗保险补充和医疗补助多州数据库进行估计。直接非医疗保健成本针对执法、无家可归者收容所以及研究与培训进行估计。间接成本针对失业导致的生产力损失、就业者工作生产力下降、过早死亡（即自杀）以及护理进行估计。
2013年精神分裂症的经济负担估计为1557亿美元（根据敏感性分析为1344亿美元 - 1743亿美元），与无精神分裂症的个体相比，包括额外的直接医疗保健成本377亿美元（24%）、直接非医疗保健成本93亿美元（6%）以及间接成本1173亿美元（76%）。最大的组成部分是与失业相关的额外成本（38%）、护理导致的生产力损失（34%）以及直接医疗保健成本（24%）。
精神分裂症与重大经济负担相关，除直接医疗保健成本外，间接和非医疗保健成本也是重要因素，这表明治疗不仅应旨在改善症状控制，还应改善认知和功能表现，因为这些与大量的非医疗保健和间接成本相关。
