Cost-effectiveness of a free drug program for schizophrenia in Beijing, China

Disease burden of schizophrenia patients visiting a Chinese regional mental health centre

Aim & methods: A decision-analytic model was constructed to simulate a real-world cohort of Chinese patients visiting a Chinese regional mental health center for long-term health outcomes and direct medical costs. Results: When compared with age and gender-matched general population, the Chinese patients with schizophrenia were associated with reduced overall survival by 20.6 years (27.6 vs 48.2 years) and reduced quality-adjusted life years (QALY) by 18.4 QALY (18.4 vs 36.8 QALY), respectively, and increased lifetime direct medical costs by about three-times (US$84,324 vs 33,387 as of 31 December 2017) on average. Conclusion: The burden of schizophrenia was mainly driven by the mortality associated with relapsed schizophrenia and direct medical costs for schizophrenia in local mental health rehabilitation institutes.

Impact of community-based rehabilitation for mental illness on 'out of pocket' expenditure in rural South India

In India, expenditure incurred to access mental health services often drives families to economic crisis. Families of Persons with mental illness (PMI) incur 'out-of-pocket' (OOP) expenditure for medicines, psychiatrist fee and travel in addition to losing wages on the day of visiting psychiatrist.

AIM

To describe impact of Community Based Rehabilitation (CBR) on OOP expenditure incurred by families of persons with severe mental illness (PSMI).

METHODS

The sample comprised 95 PSMI who switched from treatment from other mental health facilities to CBR at Jagaluru, India.

RESULTS

The PSMI were predominantly male (52%) with mean age 41 years and diagnosed with psychosis (75%). Most of them (84%) were earlier taking treatment from private sector and spent on an average Rs. 15,074 (US $ 215) per PSMI per annum in availing treatment. After availing CBR, the annual expenditure reduced to Rs 492 (US $ 7) on an average per PSMI. OOP expenditure on medicines (largest head of expenditure) and psychiatrist consultation fee dropped to zero.

DISCUSSION

After excluding costs incurred to run the CBR, the net savings for the system for 95 PSMI included in study alone was Rs 3,83,755 (US $ 5,482) per annum. The amount would be much higher on including savings for PSMI initiated on treatment for the first time and PMI on regular follow-up in CBR.

CONCLUSIONS

Provision of CBR in partnership with public health system and NGO's leads to dramatic fall in OOP health expenditure of families of PSMI. It is also cost-effective to the system.