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Ki Y, McAleavey AA, Moger TA, Moltu C. Cost structure in specialist mental healthcare: what are the main drivers of the most expensive episodes? Int J Ment Health Syst 2023; 17:37. [PMID: 37946305 PMCID: PMC10633930 DOI: 10.1186/s13033-023-00606-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 10/06/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Mental disorders are one of the costliest conditions to treat in Norway, and research into the costs of specialist mental healthcare are needed. The purpose of this article is to present a cost structure and to investigate the variables that have the greatest impact on high-cost episodes. METHODS Patient-level cost data and clinic information during 2018-2021 were analyzed (N = 180,220). Cost structure was examined using two accounting approaches. A generalized linear model was used to explain major cost drivers of the 1%, 5%, and 10% most expensive episodes, adjusting for patients' demographic characteristics [gender, age], clinical factors [length of stay (LOS), admission type, care type, diagnosis], and administrative information [number of planned consultations, first hospital visits, interval between two hospital episode]. RESULTS One percent of episodes utilized 57% of total resources. Labor costs accounted for 87% of total costs. The more expensive an episode was, the greater the ratio of the inpatient (ward) cost was. Among the top-10%, 5%, and 1% most expensive groups, ward costs accounted for, respectively, 89%, 93%, and 99% of the total cost, whereas the overall average was 67%. Longer LOS, ambulatory services, surgical interventions, organic disorders, and schizophrenia were identified as the major cost drivers of the total cost, in general. In particular, LOS, ambulatory services, and schizophrenia were the factors that increased costs in expensive subgroups. The "first hospital visit" and "a very short hospital re-visit" were associated with a cost increase, whereas "the number of planned consultations" was associated with a cost decrease. CONCLUSIONS The specialist mental healthcare division has a unique cost structure. Given that resources are utilized intensively at the early stage of care, improving the initial flow of hospital care can contribute to efficient resource utilization. Our study found empirical evidence that planned outpatient consultations may be associated with a reduced health care burden in the long-term.
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Affiliation(s)
- Yeujin Ki
- Department of Research and Innovation, Helse Førde, Førde, Norway.
| | - Andrew Athan McAleavey
- Department of Research and Innovation, Helse Førde, Førde, Norway
- Department of Health and Caring Sciences, Western Norway University of Applied Science, Bergen, Norway
| | - Tron Anders Moger
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
- Section of Medical Statistics, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Christian Moltu
- Department of Psychiatry, Helse Førde, Førde, Norway
- Department of Health and Caring Sciences, Western Norway University of Applied Science, Bergen, Norway
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Senese F, Rucci P, Fantini MP, Gibertoni D, Semrov E, Nassisi M, Messina R, Travaglini C. Measuring costs of community mental health care in Italy: A prevalence-based study. Eur Psychiatry 2018. [PMID: 29514117 DOI: 10.1016/j.eurpsy.2018.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Information on individual mental healthcare costs and utilization patterns in Italy is scant. We analysed the use and the annual costs of community mental health services (MHS) in an Italian local health authority (LHA). Our aims are to compare the characteristics of patients in the top decile of costs with those of the remaining 90%, and to investigate the demographic and clinical determinants of costs. METHODS This retrospective study is based on administrative data of adult patients with at least one contact with MHS in 2013. Costs of services were estimated using a microcosting method. We defined as high cost (HC) those patients whose community mental health services costs place them in the top decile of the cost distribution. The predictors of costs were investigated using multiple linear regression. RESULTS The overall costs borne for 7601 patients were 17 million €, with HC accounting for 87% of costs and 73% of services. Compared with the rest of the patients, HC were younger, more likely to be male, to have a diagnosis of psychosis, and longer and more intensive MHS utilization. In multiple linear regression, younger age, longer duration of contact with MHS, psychosis, bipolar disorder, personality disorder, depression, dementia and Italian citizenship accounted for 20.7% of cost variance. CONCLUSION Direct mental health costs are concentrated among a small fraction of patients who receive intensive socio-rehabilitation in community services. One limitation includes the unavailability of hospital costs. Our methodology is replicable and useful for national and cross-national benchmarking.
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Affiliation(s)
- F Senese
- Regional Agency for Health and Social Care, Bologna, Italy
| | - P Rucci
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University, Bologna, Italy.
| | - M P Fantini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University, Bologna, Italy
| | - D Gibertoni
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University, Bologna, Italy
| | - E Semrov
- Department of Mental Health and Pathological Dependences, Reggio Emilia, Italy
| | - M Nassisi
- Department of Mental Health and Pathological Dependences, Reggio Emilia, Italy
| | - R Messina
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University, Bologna, Italy
| | - C Travaglini
- Department of Management, Alma Mater Studiorum University, Bologna, Italy
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Einarson TR, Bereza BG, Garcia Llinares I, González Martín Moro B, Tedouri F, Van Impe K. Cost-effectiveness of 3-month paliperidone treatment for chronic schizophrenia in Spain. J Med Econ 2017; 20:1039-1047. [PMID: 28678566 DOI: 10.1080/13696998.2017.1351370] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND A 3-month long treatment of paliperidone palmitate (PP3M) has been introduced as an option for treating schizophrenia. Its cost-effectiveness in Spain has not been established. AIMS To compare the costs and effects of PP3M compared with once-monthly paliperidone (PP1M) from the payer perspective in Spain. METHODS This study used the recently published trial by Savitz et al. as a core model over 1 year. Additional data were derived from the literature. Costs in 2016 Euros were obtained from official lists and utilities from Osborne et al. The authors conducted both cost-utility and cost-effectiveness analyses. For the former, the incremental cost per quality-adjusted life-year (QALY) gained was calculated. For the latter, the outcomes were relapses and hospitalizations avoided. To assure the robustness of the analyses, a series of 1-way and probability sensitivity analyses were conducted. RESULTS The expected cost was lower with PP3M (4,780€) compared with PP1M (5,244€). PP3M had the fewest relapses (0.080 vs 0.161), hospitalizations (0.034 v.s 0.065), and emergency room visits (0.045 v.s 0.096) and the most QALYs (0.677 v.s 0.625). In both cost-effectiveness and cost-utility analyses, PP3M dominated PP1M. Sensitivity analyses confirmed base case findings. For the primary analysis (cost-utility), PP3M dominated PP1M in 46.9% of 10,000 simulations and was cost-effective at a threshold of 30,000€/QALY gained. CONCLUSIONS PP3M dominated PP1M in all analyses and was, therefore, cost-effective for treating chronic relapsing schizophrenia in Spain. For patients who require long-acting therapy, PP3M appears to be a good alternative anti-psychotic treatment.
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Affiliation(s)
- Thomas R Einarson
- a Leslie Dan Faculty of Pharmacy , University of Toronto , Toronto , ON , Canada
| | - Basil G Bereza
- a Leslie Dan Faculty of Pharmacy , University of Toronto , Toronto , ON , Canada
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Siskind D, Harris M, Diminic S, Carstensen G, Robinson G, Whiteford H. Predictors of mental health-related acute service utilisation and treatment costs in the 12 months following an acute psychiatric admission. Aust N Z J Psychiatry 2014; 48:1048-58. [PMID: 25030807 DOI: 10.1177/0004867414543566] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE A key step in informing mental health resource allocation is to identify the predictors of service utilisation and costs. This project aims to identify the predictors of mental health-related acute service utilisation and treatment costs in the year following an acute public psychiatric hospital admission. METHOD A dataset containing administrative and routinely measured outcome data for 1 year before and after an acute psychiatric admission for 1757 public mental health patients was analysed. Multivariate regression models were developed to identify patient- and treatment-related predictors of four measures of service utilisation or cost: (a) duration of index admission; and, in the year after discharge from the index admission (b) acute psychiatric inpatient bed-days; (c) emergency department (ED) presentations; and (d) total acute mental health service costs. Split-sample cross-validation was used. RESULTS A diagnosis of psychosis, problems with living conditions and prior acute psychiatric inpatient bed-days predicted a longer duration of index admission, while prior ED presentations and self-harm predicted a shorter duration. A greater number of acute psychiatric inpatient bed-days in the year post-discharge were predicted by psychosis diagnosis, problems with living conditions and prior acute psychiatric inpatient admissions. The number of future ED presentations was predicted by past ED presentations. For total acute care costs, diagnosis of psychosis was the strongest predictor. Illness acuity and prior acute psychiatric inpatient admission also predicted higher costs, while self-harm predicted lower costs. DISCUSSION The development of effective models for predicting acute mental health treatment costs using existing administrative data is an essential step towards a workable activity-based funding model for mental health. Future studies would benefit from the inclusion of a wider range of variables, including ethnicity, clinical complexity, cognition, mental health legal status, electroconvulsive therapy, problems with activities of daily living and community contacts.
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Affiliation(s)
- Dan Siskind
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Queensland Health, Brisbane, Australia School of Population Health, The University of Queensland, Brisbane, Australia Diamantina Health Partners, Neuroscience, Recovery and Mental Health, Brisbane, Australia Metro South Addiction and Mental Health Service, Brisbane, Australia
| | - Meredith Harris
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Queensland Health, Brisbane, Australia School of Population Health, The University of Queensland, Brisbane, Australia
| | - Sandra Diminic
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Queensland Health, Brisbane, Australia School of Population Health, The University of Queensland, Brisbane, Australia
| | - Georgia Carstensen
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Queensland Health, Brisbane, Australia School of Population Health, The University of Queensland, Brisbane, Australia
| | - Gail Robinson
- Diamantina Health Partners, Neuroscience, Recovery and Mental Health, Brisbane, Australia Metro South Addiction and Mental Health Service, Brisbane, Australia Griffith Health Institute, Griffith University, Logan Academic Campus, Meadowbrook, Australia
| | - Harvey Whiteford
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Queensland Health, Brisbane, Australia School of Population Health, The University of Queensland, Brisbane, Australia
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Jiménez J, Rivera D, Benítez P, Tarrats H, Ramos A. Integrating mental health services into a general hospital in Puerto Rico. J Clin Psychol Med Settings 2014; 20:294-301. [PMID: 23543328 DOI: 10.1007/s10880-012-9352-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The prevalence of mental health problems in the general population should be carefully considered. The literature has reported a high co-morbidity of medical and mental illnesses; therefore, collaborative efforts incorporating psychological services into medical settings are imperative. In Puerto Rico, this is not a regular practice in general hospitals. Improving access to mental health services is a challenge and requires the creation of new venues within the healthcare system. This paper describes the theoretical framework, mission, and objectives of the Clinical Psychology Services Program (CPSP) implemented at Damas Hospital in Puerto Rico. From December 2002 to December 2010, a total of 13,580 visits were made to inpatients in diverse clinical units of the hospital; 61% of all inpatients evaluated met the criteria for at least one mental health disorder based on the DSM-IV-TR. The CPSP's outcomes highlight the acceptance and relevance of incorporating mental health services and clinical psychologists into general hospitals.
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Affiliation(s)
- J Jiménez
- Clinical Psychology Department, Ponce School of Medicine and Health Sciences, P.O. Box 7004, Ponce, PR 00732-7004, USA.
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Mandell DS, Xie M, Morales KH, Lawer L, McCarthy M, Marcus SC. The interplay of outpatient services and psychiatric hospitalization among Medicaid-enrolled children with autism spectrum disorders. ACTA ACUST UNITED AC 2012; 166:68-73. [PMID: 22213753 DOI: 10.1001/archpediatrics.2011.714] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To examine whether increased provision of community-based services is associated with decreased psychiatric hospitalizations among children with autism spectrum disorders (ASDs). DESIGN Retrospective cohort study using discrete-time logistic regression to examine the association of service use in the preceding 60 days with the risk of hospitalization. SETTING The Medicaid-reimbursed health care system in the continental United States. PARTICIPANTS Medicaid-enrolled children with an ASD diagnosis in 2004 (N = 28 428). MAIN EXPOSURES Use of respite care and therapeutic services, based on procedure codes. MAIN OUTCOME MEASURES Hospitalizations associated with a diagnosis of ASD (International Classification of Diseases, 10th Revision, codes 299.0, 299.8, and 299.9). RESULTS Each $1000 increase in spending on respite care during the preceding 60 days resulted in an 8% decrease in the odds of hospitalization in adjusted analysis. Use of therapeutic services was not associated with reduced risk of hospitalization. CONCLUSIONS Respite care is not universally available through Medicaid. It may represent a critical type of service for supporting families in addressing challenging child behaviors. States should increase the availability of respite care for Medicaid-enrolled children with ASDs. The lack of association between therapeutic services and hospitalization raises concerns regarding the effectiveness of these services.
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Affiliation(s)
- David S Mandell
- Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, Third Floor, Philadelphia, PA 19104, USA.
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The difficult task of predicting the costs of community-based mental health care. A comprehensive case register study. Epidemiol Psychiatr Sci 2011; 20:245-56. [PMID: 21922967 DOI: 10.1017/s2045796011000473] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Previous studies have attempted to forecast the costs of mental health care, using clinical and individual variables; the inclusion of ecological measures could improve the knowledge of predictors of psychiatric service utilisation and costs to support clinical and strategic decision-making. METHODS Using a Psychiatric Case Register (PCR), all patients with an ICD-10 psychiatric diagnosis, who had at least one contact with community-based psychiatric services in the Verona Health District, Northern Italy, were included in the study (N = 4558). For each patient, one year's total cost of care was calculated by merging service contact data with unit cost estimates and clinical and socio-demographic variables were collected. A socio-economic status (SES) index was developed, as a proxy of deprivation, using census data. Multilevel multiple regression models, considering socio-demographic and clinical characteristics of patients as well as socioeconomic local characteristics, were estimated to predict costs. RESULTS The mean annual cost for all patients was 2,606.11 Euros; patients with an ongoing episode of care and with psychosis presented higher mean costs. Previous psychiatric history represented the most significant predictor of cost (36.99% R2 increase) and diagnosis was also a significant predictor but explained only 4.96% of cost variance. Psychiatric costs were uniform throughout the Verona Health District and SES characteristics alone contributed towards less than 1% of the cost variance. CONCLUSIONS For all patients of community-based psychiatric services, a comprehensive model, including both patients' individual characteristics and socioeconomic local status, was able to predict 43% of variance in costs of care.
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Chand P, Murthy P, Arunachalam V, Naveen Kumar C, Isaac M. Service utilization in a tertiary psychiatric care setting in South India. Asian J Psychiatr 2010; 3:222-6. [PMID: 23050892 DOI: 10.1016/j.ajp.2010.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Revised: 07/20/2010] [Accepted: 08/01/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To carry out an audit reviewing the utilization of psychiatric services and types of disorders presenting to a tertiary care psychiatry hospital in a developing Asian country. METHOD Consecutive adult patients who came for detailed consultation in 1 year were included in this study. A senior consultant psychiatrist reconfirmed the diagnosis in each patient who underwent detailed psychiatric evaluation. Psychiatric evaluation consists of clinical history from the patients and the relatives and a mental state examination. Data was obtained from the detailed work up evaluation psychiatry records of these patients. RESULTS Mood disorder was the most common diagnosis followed by substance use disorders and psychotic disorders (ICD 10). There is a substantial delay of more than 2-5 years for seeking treatment in most disorders including schizophrenia. More than 80% of the population directly seeks treatment at this tertiary hospital. Sixty-four percent of the patients came for at least one follow up. CONCLUSION The result suggests the urgent need for strengthening community care in India and similar low and middle-income countries for early and optimal treatment.
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Affiliation(s)
- Prabhat Chand
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore 560029, India
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Evolutionary fuzzy rule extraction for subgroup discovery in a psychiatric emergency department. Soft comput 2010. [DOI: 10.1007/s00500-010-0670-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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