Article Abstract

Online ISSN: 1099-176X    Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 27, Issue 1, 2024. Pages: 13-21
Published Online: 1 March 2024

Copyright © 2024 ICMPE.

The Economic Burden of Chronic Psychotic Disorders: An Incidence-based Cost-of-Illness Approach

Claire de Oliveira¹* and Bryan Tanner²

¹Institute for Mental Health Policy Research, Centre for Addiction and Mental Health; Campbell Family Mental Health Research Institute,
Centre for Addiction and Mental Health; ICES; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health,
University of Toronto, Toronto, Canada.
²Institute for Mental Health Policy Research, Centre for Addiction and Mental Health; ICES, Toronto, Ontario, Canada

Few studies have estimated the economic burden of chronic psychotic disorders using an incidence-based approach. This study estimated the direct cumulative mean health care costs of chronic psychotic disorders, using an incidence-based, cost-of-illness approach and real-world data from a single-payer health care system (i.e., Ontario, Canada). Using a robust cost estimator, discounted cumulative mean health care costs were estimated from diagnosis to death or the end of observation period for the 1-, 5-, 10- and 15-periods: $24,420.08, 95% CI ($24,145.24-$24,694.92), $69,945.65, 95% CI ($69,018.79-$70,872.52), $115,142.91, 95% CI ($113,378.25-$116,907.57), and $153,332.13 ($151,121.74-$155,542.52), respectively. Cumulative costs were generally higher for males. Psychiatric hospitalisations made up the largest share of costs. Results suggest that costs of chronic psychotic disorders are high in the year of diagnosis and then increase at a decreasing rate thereafter. These estimates will serve as important inputs for policymakers looking to make decisions around resource allocation.

Background: The economic burden of chronic psychotic disorders is substantial. However, few studies have employed an incidence based approach to estimate the economic burden of chronic psychotic disorders. Furthermore, the existing work has mainly used models populated with data obtained from published literature, making several assumptions to estimate incidence-based costs.

Aims of the Study: The objective of this study was to estimate the direct cumulative mean health care costs of chronic psychotic disorders, using an incidence-based, cost-of-illness approach and real-world data from a single-payer health care system.

Methods: Using health records from Ontario, Canada, all individuals with a valid health card number, residing in the province, and diagnosed with a chronic psychotic disorder between the ages of 16 and 45 from April 1^st, 2006, to March 31^st, 2021, were included in the analysis. Using a mix of bottom-up and top-down methodologies and a robust cost estimator, cumulative mean health care costs were estimated from diagnosis to death or the end of observation period. Cumulative mean health care costs, and respective 95% confidence intervals (CIs), were estimated for the 1-year period (i.e., first year post-diagnosis), overall, by sex, age groups and health service, and for the 5-, 10- and 15-periods, overall and by sex.

Results: One-, 5-, 10- and 15-year total discounted cumulative mean health care costs were estimated at $24,441.16, 95% CI ($24,166.13, $24,716.19), $70,754.69, 95% CI ($69,827.48-$71,681.89), $117,136.88, 95% CI ($115,370.40-$118,903.35), and $157,829.01 95% CI ($155,599.32.-$160,058.70), respectively. Total mean 1-year costs post-diagnosis were higher for younger individuals. Although females had higher 1-year costs, males had higher 5-, 10- and 15-year costs. Psychiatric hospitalisations made up the largest component of total costs across all cost estimates.

Discussion: These results suggest that the costs of chronic psychotic disorders are high in the year of diagnosis and then increase at a decreasing rate thereafter. Compared to previous work, the cost estimates from the present study suggest that the use of real-world data produces lower estimates of cumulative costs, albeit likely more accurate ones. However, these estimates do not account for costs of care provided in community-based agencies.

Implications for Health Policies: These estimates will serve as important inputs for policymakers looking to make decisions around resource allocation.

Implications for Future Research: Future research should seek to follow incident cases in administrative data over a longer time period to obtain cumulative costs of longer duration.