Direct costs of schizophrenia in Italian Community psychiatric services

Objective: To estimate resource utilisation and direct costs of treatment for patients with schizophrenia in Italian Community Mental Health Centers (CMHCs). Design: Multicentre, retrospective observational study. CMHCs recruited all patients who attended a follow-up consultation during the period September to December 1998. At enrolment, psychiatrists completed a questionnaire on consumption of resources in the 2 months before recruitment. Setting: 14 CMHCs. Perspective: Italian National Health Service (INHS). Patients: 702 patients with a diagnosis of schizophrenia or other psychotic disorders, defined according to the Diagnostic and Statistical Manual of Mental Disorders-fourth edition. These patients had been followed by the CMHCs for at least 2 years and attended a follow-up consultation either during the period September to December 1998 or on randomly selected days during this period. Patients were classified into seven groups according to their diagnosis. Results: The mean direct cost of patients with schizophrenia in the 2-month observation period was 2 234 475 Italian lire [L] (1154.01 Euro; EUR); direct costs ranged from L.1 545 818 to L.2 775 658 (EUR798.35 to EUR1433.51) by prognostic group. There was wide variability for prognostic groups in the impact of most cost components on total cost. Admissions accounted for between 11.4 and 56.3% of the total cost, daycare centre days for between 11.3 and 35.5%, home visits for 7.8 to 16.4%, and day-hospital days for 5.4 to 32.8%. Anti-psychotics and anxiolytics were the most prescribed drugs and also the most costly. Conclusion: Despite the limitations of the study related to the short period considered, we believe this study offers some interesting information on the burden of schizophrenia, a disease for which its cost has received limited attention so far in Italy