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.