Economic burden of schizophrenia in Italy: a probabilistic cost of illness analysis

Andrea Marcellusi, Gianluca Fabiano, Raffaella Viti, Pier Cesare Francesa Morel, Giuseppe Nicolò, Alberto Siracusano, Francesco Saverio Mennini, Andrea Marcellusi, Gianluca Fabiano, Raffaella Viti, Pier Cesare Francesa Morel, Giuseppe Nicolò, Alberto Siracusano, Francesco Saverio Mennini

Abstract

Objectives: Schizophrenia is a chronic, debilitating psychiatric disease with highly variable treatment pathways and consequent economic impacts on resource utilisation. The aim of the study was to estimate the economic burden of schizophrenia in Italy for both the societal and Italian National Healthcare perspective.

Methods: A probabilistic cost of illness model was applied. A systematic literature review was carried out to identify epidemiological and economic data. Direct costs were calculated in terms of drugs, hospitalisations, specialist services, residential and semiresidential facilities. Indirect costs were calculated on the basis of patients' and caregivers' loss of productivity. In addition, the impact of disability compensation was taken into account using a database from the Italian National Social Security Institute -Italy (INPS).

Results: Overall, 303 913 prevalent patients with schizophrenia were estimated. Of these, 212 739 (70%) were diagnosed and 175 382 (82%) were treated with antipsychotics. The total economic burden was estimated at €2.7 billion (95% CI €1771.93 to €3988.65), 50.5% due to indirect costs and 49.5% to direct costs. Drugs corresponded to 10% of direct costs and hospitalisations (including residential and semiresidential facilities) accounted for 81%.

Conclusions: This study highlighted that indirect costs and hospitalisations (including residential and semiresidential facilities) play a major role within the expenses associated with schizophrenia in Italy, and this may be considered as a tool for public decision-makers.

Keywords: Italy; burden of disease; cost Of illness.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
Breakdown of CoI model. FGA, first-generation antipsychotics; SGA, second-generation antipsychotics.
Figure 2
Figure 2
Direct costs and probabilistic results (95% CI), Euro million.
Figure 3
Figure 3
Direct costs per year, Italy.
Figure 4
Figure 4
Indirect costs and probabilistic results (95% CI), Euro million.

References

    1. Gustavsson A, Svensson M, Jacobi F, et al. . Cost of disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 2011;21:718–79. 10.1016/j.euroneuro.2011.08.008
    1. Tansella M, De Girolamo G. La diffusione dei disturbi mentali nella comunità. Roma: Dipartimento di Medicina e Sanità Pubblica, Sezione di Psichiatria, Università di Verona; Progetto Nazionale Salute Mentale, Laboratorio di Epidemiologia, Istituto Superiore di Sanità, 2005.
    1. Saha S, Chant D, Welham J, et al. . A systematic review of the prevalence of schizophrenia. PLoS Med 2005;2:e141 10.1371/journal.pmed.0020141
    1. Altamura C, Galderisi P, Rocca A, et al. . Schizophrenia today: epidemiology, diagnosis, course and models of care. Ital J Psychopathol 2014;20:223–43.
    1. Altamura AC, Serati M, Albano A, et al. . An epidemiologic and clinical overview of medical and psychopathological comorbidities in major psychoses. Eur Arch Psychiatry Clin Neurosci 2011;261:489–508. 10.1007/s00406-011-0196-4
    1. Knapp M, Mangalore R, Simon J. The global costs of schizophrenia. Schizophr Bull 2004;30:279–93. 10.1093/oxfordjournals.schbul.a007078
    1. Rocca P, Giugiaro M, Bogetto F. Compliance in the treatment of schizophrenia. Rivista di psichiatria 2006.
    1. Garattini L, Barbui C, Clemente R, et al. . Direct costs of schizophrenia and related disorders in Italian community mental health services: a multicenter, prospective 1-year followup study. Schizophr Bull 2004;30:295–302. 10.1093/oxfordjournals.schbul.a007079
    1. Garattini L, Rossi C, Tediosi F, et al. . Direct costs of schizophrenia in Italian community psychiatric services. Pharmacoeconomics 2001;19:1217–25. 10.2165/00019053-200119120-00004
    1. Cortesi PA, Mencacci C, Luigi F, et al. . Compliance, persistence, costs and quality of life in young patients treated with antipsychotic drugs: results from the COMETA study. BMC Psychiatry 2013;13:98 10.1186/1471-244X-13-98
    1. Niolu C, Barone Y, Bianciardi E, et al. . Predictors of poor adherence to treatment in inpatients with bipolar and psychotic spectrum disorders. Riv Psichiatr 2015;50:285–94. 10.1708/2098.22686
    1. Niolu C, Bianciardi E, Di Lorenzo G, et al. . Enhancing adherence, subjective well-being and quality of life in patients with schizophrenia: which role for long-acting risperidone? Ther Adv Psychopharmacol 2015;5:278–88. 10.1177/2045125315596897
    1. Marcellusi A, Mecozzi A, Mennini FS. Direct and indirect cost of diabetes in italy: a prevalence probabilistic approach: CEIS Tor Vergata Research paper series, 2014.
    1. Baio G, Capone A, Marcellusi A, et al. . Economic burden of human papillomavirus-related diseases in Italy. PLoS One 2012;7:e49699 10.1371/journal.pone.0049699
    1. Marcellusi A, Viti R, Capone A, et al. . Costi diretti e indiretti assorbiti dalle patologie HCV-indotte in Italia: stima basata su una metodologia probabilistica di cost of illness. PharmacoEconomics Italian Research Articles 2014;16:1–10. 10.1007/s40276-014-0023-9
    1. Marcellusi A, Viti R, Capone A, et al. . The economic burden of HCV-induced diseases in Italy. A probabilistic cost of illness model. Eur Rev Med Pharmacol Sci 2015;19:1610–20.
    1. Marcellusi A, Viti R, Incorvaia C, et al. . [Direct and indirect costs associated with respiratory allergic diseases in Italy. A probabilistic cost of illness study]. Recenti Prog Med 2015;106:517–27. 10.1701/2032.22086
    1. Marcellusi A, Viti R, Mecozzi A, et al. . The direct and indirect cost of diabetes in Italy: a prevalence probabilistic approach. Eur J Health Econ 2016;17 10.1007/s10198-014-0660-y
    1. Marcellusi A, Viti R, Sciattella P, et al. . Economic aspects in the management of diabetes in Italy. Value Health 2015;18:A602–A603. 10.1016/j.jval.2015.09.2071
    1. Russo S, Mariani TT, Migliorini R, et al. . The economic burden of musculoskeletal disorders on the Italian social security pension system estimated by a Monte Carlo simulation. Reumatismo 2015;67:45–56. 10.4081/reumatismo.2015.811
    1. Russo S, Viti R, Marcellusi A, et al. . Direct and indirect costs associated to retinal vascular diseases in Italy. A probabilistic cost of illness study. Value Health 2015;18:A418 10.1016/j.jval.2015.09.544
    1. Fabriani V, Marcellusi A, Mennini FS, et al. . Cost of illness analysis of duchenne muscular dystrophy In Italy. Value Health 2014;17:A528 10.1016/j.jval.2014.08.1671
    1. Moher D, Liberati A, Tetzlaff J, et al. . Reprint--preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Phys Ther 2009;89:873–80.
    1. Moher D, Liberati A, Tetzlaff J, et al. . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 2009;62:1006–12. 10.1016/j.jclinepi.2009.06.005
    1. Lieberman JA, Stroup TS, McEvoy JP, et al. . Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 2005;353:1209–23. 10.1056/NEJMoa051688
    1. Ravasio R, Sanfilippo L, De Paoli G, et al. . I costi della schizofrenia in Italia: i risultati di un’analisi condotta nell’ASL della Provincia di Pavia. Giornale Italiano di Health Technology Assessment 2009;2:19–28. 10.1007/BF03320715
    1. Salute MD. Gli interventi precoci nella schizofrenia, in Sistema nazionale per le linee guida, 2009.
    1. ISTAT. 2015.
    1. Gaddini A, Arcà M, Fratini S. Rapporto sull’attività dei Centri di Salute Mentale, dei Centri Diurni e delle Strutture Residenziali psichiatriche del Lazio: ASP Regione Lazio, 2014.
    1. Degli Esposti L, Sangiorgi D, Mencacci C, et al. . Pharmaco-utilisation and related costs of drugs used to treat schizophrenia and bipolar disorder in Italy: the IBIS study. BMC Psychiatry 2014;14:282 10.1186/s12888-014-0282-z
    1. Santone G, Bellantuono C, Rucci P, et al. . Patient characteristics and process factors associated with antipsychotic polypharmacy in a nationwide sample of psychiatric inpatients in Italy. Pharmacoepidemiol Drug Saf 2011;20:441–9. 10.1002/pds.2083
    1. Ministero della Salute. Le strutture residenziali psichiatriche: Accordo conferenza unificata, 2013.
    1. Ministero della Salute. I servizi di salute mentale. 2016.
    1. ISTAT. Occupati e disoccupati (media 2014). 2014. .
    1. OCSE. Average annual wages. 2014. .
    1. INPS. Prestazioni agli Invalidi Civili Serie storica. 2014. .
    1. Briggs AH, Claxton K, Sculpher MJ. Decision modelling for health economic evaluation. Oxford handbooks in health economic evaluation. Oxford: Oxford University Press, 2006:237.
    1. Rössler W, Salize HJ, van Os J, et al. . Size of burden of schizophrenia and psychotic disorders. Eur Neuropsychopharmacol 2005;15:399–409. 10.1016/j.euroneuro.2005.04.009
    1. Frisman L. How transfer payment are treated in cost-effectiveness and cost- benefit analyses Administration and Policy in Mental Health, 1996;23.

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