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Cost-Utility Analysis of Rehabilitation of Patients with Schizophrenia
Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: The socioeconomic cost for schizophrenia is high and there is a growing interest to consider the economic consequences of introducing new rehabilitation methods in health care and other sectors of society. In order to facilitate health policy making and medical decision-making in health care from a health economic perspective, broad socioeconomic evaluations of different rehabilitation methods for patients with schizophrenia are necessary.

Aims of the study: To compare two rehabilitation strategies for patients with schizophrenia in Sweden. The new method of rehabilitation was based on interagency co-operation and teamwork involving the county council, local authorities, labor market policy agencies and the social insurance office. The alternative treatment method was traditional rehabilitation activities. The rehabilitation methods were compared with respect to differences in socioeconomic costs, transfer payments and quality of life.

Methods: It was a pre/post intervention cohort study in Sweden conducted in 1998. Data were gathered prospectively by postal questionnaires from 52 consecutively included, unemployed schizophrenic patients during a period of 6 months before and 6 months after a rehabilitation intervention. The patients had been ill for five years on average. The mean age was 29 years and the proportion of women was 56%. Data on costs, transfer payments and quality of life (EuroQol) were registered.The analytical method used was cost-utility analysis.

Results: The new rehabilitation program improved health status by 26% (p=0.007) and health related quality of life by 27% (p=0.0002), which corresponded with a change in quality adjusted life years. The total socioeconomic costs decreased, by 28% (p=0.018), SEK 19 000 per patient. The healthcare costs decreased by 51% (p=0.005) and the costs for the labor market policy agencies decreased by 90% (p=0.004). There were no significant changes in costs for the local authorities and the social insurance oflice at the 5% level. There were no changes in transfer pay- .ments at the 5% level, SEK 49 000/patient.

Discussion: The co-operative strategy in the rehabilitation of patients with schizophrenia was cost-effective for health care and society. The cohort design allowed for some uncertainty over time. However, the patients' health status had been constant for a long period before the intervention, so the impact is minimized. In order to study long-term changes in social insurance expenditures and indirect costs, the time period for the studies must be longer.

Conclusion: Interagency co-operation in rehabilitation saved money for health care and society and improved health status, health related quality of life and quality adjusted life years. It is necessary to discuss the principles for shared financial responsibility as well as incentives for monitoring resource allocations in the field of rehabilitation. Additional studies, preferably long-term, randomized, controlled trials, are needed. In the search for predictors of cost-effective rehabilitation technologies,studies of the impact of motivation on costs and quality of life are useful.

Keyword [en]
Mental illness, Schizophrenia, Rehabilitation, Cost-Utility, Quality of Life
National Category
Social Sciences Interdisciplinary
URN: urn:nbn:se:liu:diva-79118OAI: diva2:538280
Available from: 2012-06-29 Created: 2012-06-29 Last updated: 2012-06-29Bibliographically approved
In thesis
1. Disability, rehabilitation and health economic assessment
Open this publication in new window or tab >>Disability, rehabilitation and health economic assessment
2001 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Disability caused by long-term illnesses and diseases involves welfare losses through human suffering and huge societal costs. Rehabilitation of disabled individuals is a complex and growing field where health economic assessment studies could play a role in health policy and medical decision-making.

Aims: The overall aim was the application of a multidisdplinary framework of health economic assessment of rehabilitation technologies for disabled individuals. A specific aim was to examine the costs for some disabilitygroups, and another aim was to examine the cost-effectiveness of certain rehabilitation technologies for disabled individuals.

Methods: Six empirical studies were used. Cost analyses were applied to disabilities caused by long-term illnesses (Paper I), rheumatic· diseases (Paper II), and severe schiwphrenia (Paper III). A cost-effectivenessanalysis was performed on the rehabilitation of disabled patients with severe schizophrenia {Paper IV). Costutilily analyses were carried out on the rehabilitation of disabled patients with long-term illnesses (Paper V)and schizophrenia (Paper VI).

Results: The socioeconomic costs for the studied disability groups was SEK 1.9 billion for severe schizophrenia, SEK 25.6 billion for long term illness and SEK 62 billion for rheumatic diseases. The proportions of indirect productivity costs were considerable, 67-92% of total costs, and the social insurance expenditures were also high. Rehabilitation technologies based on co-operation between resource providers for disabled patients with schizophrenia improved health status by 26%, health-related quality of life by 27% and quality adjusted life years (QALY's). The costs for health care decreased significantly by 51% and sociely by 28%. Early rehabilitation of disabled patients with severe schizophrenia improved health status, social functioning and increased the health care costs. Rehabilitation of disabled patients with long-term illnesses did not improve health statu..~, quality of life and QALY's in the short run. The costs decreased for health care and the indirect costs increased. In optimizing the cost-effectiveness of rehabilitation technologies, disabled individuals must be precisely defined into homogeneous groups that match well-defined rehabilitation technologies. The costs for all resource providers in rehabilitation must be included in the cost concept in order to avoid underestimation of the socioeconomic costs. A financial analysis of transfer payments was valuable from a decision-maker perspective. The EuroQol-instrumem was sensitive in detecting significant changesin health status and health related qualily of life. One of the shortcomings in the study design i,s due to the lack of resources for health economic assessment studies. Long-term, randomized, controlled studies arc needed.

Conclusions: The application of the framework for health economic assessment to the rehabilitation of disabled individuals showed that the costs for disabilities in society were high, as was the proportion of indirectcosts. Co-operation among resource providers involved in rehabilitation can increase quality of life and save money for health care and society.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2001. 62 p.
Linköping Studies in Arts and Science, ISSN 0282-9800 ; 239
Disability, Rehabilitation, Cost-effectiveness, Cost-Utility, Quality of Life, Rehabilitering, Kostnadseffektivitet, Hälsoekonomi, Sjukvårdsekonomi, Livskvalitet
National Category
Social Sciences Interdisciplinary
urn:nbn:se:liu:diva-35036 (URN)24711 (Local ID)91-7373-110-2 (ISBN)24711 (Archive number)24711 (OAI)
Public defence
2001-09-12, Berzeliussalen, Hälsouniversitetet, Linköping, 13:00 (Swedish)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2014-08-28Bibliographically approved

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