Economic burden of schizophrenia: empirical analyses from a survey in Thailand.

BACKGROUND: Evidence consistently indicates that schizophrenia is a costly disease although it is not a high prevalence disorder. There are a few studies in developing countries but no study in Thailand reporting the cost of schizophrenia from a societal perspective. Health policy makers need to be aware of the cost of health care for people with schizophrenia as well as the economic burden on patients and families.

AIMS OF THE STUDY: This study aims to provide a detailed breakdown of the costs attributed to schizophrenia including the consumption of public health care resources by people with schizophrenia and the negative consequences on patients and families due to productivity losses.

METHODS: Data from a survey conducted in 2008 among people in treatment for schizophrenia were used to estimate annual medical costs for treatment including outpatient services, hospitalization and patient travel. Indirect costs were estimated for reported productivity losses of patients and families. Uncertainty analysis was performed using Monte Carlo simulation methods. We tested the sensitivity of varying assumptions about market wages to estimate productivity losses. All cost estimates are adjusted to 2008 using the Consumer Price Index and reported in Thai baht (THB). The average annual exchange rate of Thai baths to one US dollar was 33.5 in 2008.

RESULTS: The annual overall cost of schizophrenia was estimated to be THB 87 000 (USD 2600) (95% CI: 83 000, 92 000) per person or THB 31 000 million (USD 925 million) (95% CI: 26 000, 37 000) for the entire population with schizophrenia in Thailand. Indirect costs due to high unemployment, absenteeism and presenteeism of patients and families accounted for 61% of the total economic burden of schizophrenia. The largest component of direct medical cost was for hospitalizations (50%), followed by outpatient services and drug costs. Sensitivity analyses suggest that using labor force survey and socioeconomic status survey provided similar results, while lost productivity when the minimum wage was used was significantly less.

DISCUSSION: Productivity loss due to unemployment is the major contributor to the cost of schizophrenia. Due to data unavailability we did not include intangible costs (e.g. costs associated with pain and suffering or impact on quality of life) and direct non-health care costs (e.g. costs related to law enforcement and the criminal justice system). The survey sample is representative of only people who were in contact with mental health services and is not necessarily representative of all people with schizophrenia.

IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: In priority setting it is important that policy makers are aware of the high direct and indirect costs of schizophrenia. Providing optimal treatment (e.g. medication in combination with psychosocial interventions) could reduce some costs such has hospitalization but this may require increased investment in mental health care and time spent by patients and caregivers.