Article Abstract

Article Abstract

Online ISSN: 1099-176X Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 19, Issue 4, 2016. Pages: 181-192
Published Online: 1 December 2016

The Economic Burden of Chronic Psychotic Disorders in Ontario

Claire de Oliveira,¹ Joyce Cheng,² Jürgen Rehm,³ Paul Kurdyak⁴

¹MA, PhD, Independent Scientist/Health Economist, Centre for Addiction and Mental (CAMH), Institute for Health Policy, Management and Evaluation (IHPME), University of Toronto, Institute for Clinical Evaluative Science (ICES), Toronto, Canada
²MSc, Research Coordinator, CAMH, ICES, Toronto, Canada
³Dipl. Psych., PhD, Scientist/Director of the Institute for Mental Health Policy Research CAMH, Dalla Lana School Public Health, University of Toronto, Head of the Epidemiological Research Unit, Clinical Psychology and Psychotherapy, Dresden University of Technology, Toronto, Canada
⁴MD, MSc, PhD, FRCPC, Scientist/Director of the Health Outcomes and Performance Evaluation Research Unit, CAMH, IHPME and Department of Psychiatry, University of Toronto, ICES, Toronto, Canada

* Correspondence to: Claire de Oliveira, Independent Scientist/Health Economist, Centre for Addiction and Mental Health, Institute for Mental Health Policy Research 33 Russell Street, Room T414, Toronto, Ontario, M5S 2S1 Canada.
Tel.: +1-416-535 8501 ext. 36098
Fax: +1-416-595 6899
E-mail: claire.deoliveira@camh.ca

Source of Funding: This study was supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by the ICES or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions, and statements expressed herein are those of the authors, and not necessarily those of CIHI.

Abstract

Chronic psychotic disorders are one of the most costly mental disorders; yet, precise cost estimates are lacking. Using administrative health records, we estimated net costs of chronic psychotic disorders (i.e., the difference in cost for patients with psychosis and control subjects), using a case-control design. Mean net costs were estimated for all patients and disaggregated by sex, age group (16-24; 25-44; 45-64; 65+) and health service. We found that total direct costs were just under $2.1 billion CAD in 2012; total net costs were around $1.5 billion CAD. The main cost drivers were psychiatric hospitalizations (48%), followed by long-term care (14%). We also found important utilization/cost differences between age groups. As patients with chronic psychotic disorders become older, chronic disease and disability become more prominent. Our findings highlight the need for health care systems to address both physical and mental illness simultaneously, especially for older patients with chronic psychotic disorders.

Background: Chronic psychotic disorders are severe and disabling mental disorders associated with poor psychiatric and medical outcomes. These disorders are considered one of the most costly mental disorders due young age at onset and the need for intensive health care over the life course.

Aims of the Study: The purpose of this study was to estimate the direct health care costs of chronic psychotic disorders in Ontario in 2012 from the perspective of the third-party payer (i.e., the ministry of health), using a prevalence-based cost-of-illness approach.

Methods: We selected all patients eligible for public health insurance over the age of 15 with a diagnosis of chronic psychotic disorder, using a validated algorithm. Using linked administrative health care databases, we estimated net costs associated with chronic psychotic disorders (i.e., the difference in cost for patients with psychosis and control subjects), using a case-control design. Mean net prevalence costs were estimated for the full sample and disaggregated by sex, age group (16-24; 25-44; 45-64; 65 and over) and health service.

Results: In 2012, there were 142,821 patients with a chronic psychotic disorder in Ontario. They had a mean age of 49, were made up of slightly more males (53%) and were mostly from low-income, urban neighbourhoods. Roughly 17% of patients had a psychiatric hospitalization, with an average of 2 hospitalizations and average length of stay of 49 days. The total direct cost of patients with chronic psychotic disorders to the ministry of health was just under $2.1 billion CAD. Total net costs were around $1.5 billion CAD. The main cost drivers were psychiatric hospitalizations (48%), followed by long-term care (14%). Mean net costs were slightly higher for females than males ($10,653 vs. $10,647, respectively). Mean net costs were highest for patients 65 and over, and lowest for patients 25-44 ($15,230 vs. $8,585, respectively). The main cost drivers also varied with age. For younger patients, three-quarters of the net cost were due to psychiatric hospitalizations (74%), while for older patients net costs were mainly due long-term care (38%), followed by psychiatric (24%) and non-psychiatric (14%) hospitalizations.

Discussion and Limitations: The direct net costs of treating patients with chronic psychotic disorders are substantial and represent a sizeable portion of the Ontario health care budget (3%). Previous research has found similar findings in other jurisdictions. These estimates do not account for costs of addiction services.

Implications for Health Care Provision and Use: Our results suggest there are important utilization/cost differences between age groups. As patients with chronic psychotic disorders become older chronic disease and disability become more prominent, as reflected in higher costs with long-term care and non-psychiatric hospitalizations.

Implications for Health Policies: These findings highlight the need for health care systems to address both physical and mental illness simultaneously, especially for older patients with chronic psychotic disorders.

Implications for Further Research: Future research should focus on the predictors of care over the life course of patients with chronic psychotic disorders. In addition, further work should examine how the interplay between mental and physical health contribute to increased costs among patients with psychosis.

Received 27 August 2015; accepted 4 October 2016