Economic Evaluation and HTA (EEHTA), CEIS, Facoltà di Economia, Università di Roma "Tor Vergata", Via Columbia 2, 00133, Rome, Italy.
Department of Accounting Finance and Informatics, Kingston University, London, UK.
Clin Drug Investig. 2021 Feb;41(2):183-191. doi: 10.1007/s40261-020-00991-7. Epub 2021 Feb 9.
Schizophrenia is one of the mental disorders with the highest economic and social costs, with an important burden on patients, caregivers, and society.
The objective of this study was to estimate the direct and social security costs of schizophrenia in Italy. As far as direct costs are concerned, those related to hospitalizations and pharmaceutical expenditure have been analyzed, while disability benefits (DBs) and incapacity pensions (IPs) have been considered for the social security costs.
In order to provide annual economic burden of schizophrenia using the real-world data, we analyzed the main regional and national databases related to hospitalizations and pharmaceuticals. Hospitalizations have been analyzed considering the Hospital Information System, which collects all the information regarding hospital discharges from all public and private hospitals (psychiatric wards or residential facilities have not been considered). Hospitalizations with a discharge date between 2009 and 2016, and with a primary or secondary diagnosis of schizophrenia (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 295.xx) were selected. Hospital costs have been estimated considering the national tariffs associated with each selected hospitalization. In addition, using the same inclusion criteria, the average DBs (for workers with reduced working capacity) and IPs (for workers without working capacity) provided each year have been analyzed from the social security benefit applications database. The estimate of pharmaceutical expenditure was prepared based on the OsMed 2018 Report (Italian Medicines Agency, latest issue 18 July 2019). A one-way deterministic sensitivity analysis was conducted to examine the robustness of the results.
In Italy from 2009 to 2016, schizophrenia had an important economic impact from a social perspective. On average, 13,800 patients were hospitalized, with an average of 2.98 hospitalizations per patient. From a National Health Service (NHS) perspective and with specific reference to hospitalizations, the annual economic burden was €101.4 million, with an average cost per patient of €7338. On the other hand, pharmaceutical expenditure amounts to over €147 million each year, while residential, semi-residential, and specialist facilities amount to approximately €1 billion. Again, schizophrenia led to approximately 15,000 recipients of social security benefits (DBs and IPs) yearly from 2009 to 2015, with an average annual expenditure of €160.1 million (average cost per patient = €10,675).
Our study estimates an economic burden of schizophrenia of €1250 million per year in direct costs, of which 20% is related to hospitalizations and pharmaceutical expenditure. With regard to social security benefits, an average annual expenditure of €160.1 million was calculated (average cost per patient = €10,675).
精神分裂症是经济和社会成本最高的精神障碍之一，给患者、照顾者和社会带来了沉重的负担。
本研究旨在评估意大利精神分裂症的直接和社会保障成本。就直接成本而言，分析了与住院和药物支出相关的成本，而社会保障成本则考虑了残疾福利（DBs）和丧失工作能力养老金（IPs）。
为了使用真实世界的数据提供精神分裂症的年度经济负担，我们分析了与住院和药物相关的主要区域和国家数据库。住院治疗通过医院信息系统进行分析，该系统收集了所有来自所有公立和私立医院（不包括精神病病房或住宿设施）出院的信息。选择了出院日期在 2009 年至 2016 年之间、主要或次要诊断为精神分裂症（国际疾病分类，第九修订版，临床修正 [ICD-9-CM] 代码 295.xx）的住院患者。根据与每个选定的住院治疗相关的国家关税，估算了住院费用。此外，根据社会福利申请数据库，使用相同的纳入标准，分析了每年提供的平均 DBs（对于工作能力降低的工人）和 IPs（对于没有工作能力的工人）。药物支出的估算基于 2018 年 OsMed 报告（意大利药品管理局，最新版本为 2019 年 7 月 18 日）。进行了单向确定性灵敏度分析，以检查结果的稳健性。
2009 年至 2016 年期间，意大利精神分裂症从社会角度来看具有重要的经济影响。平均每年有 13800 名患者住院，每名患者平均住院 2.98 次。从国家卫生服务（NHS）的角度来看，具体参考住院治疗，年度经济负担为 1.014 亿欧元，每名患者的平均成本为 7338 欧元。另一方面，每年的药物支出超过 1.47 亿欧元，而住宿、半住宿和专业设施的支出约为 100 亿欧元。同样，2009 年至 2015 年期间，精神分裂症每年导致约 15000 名社会保障福利（DBs 和 IPs）的受援者，每年支出 1.601 亿欧元（每名患者的平均支出= 10675 欧元）。
我们的研究估计精神分裂症的直接成本为每年 12.5 亿欧元，其中 20%与住院和药物支出有关。关于社会保障福利，计算出每年平均支出 1.601 亿欧元（每名患者的平均支出= 10675 欧元）。
