Resumen

CABELLO RANGEL, Héctor; DIAZ CASTRO, Lina  y  ARREDONDO, Armando. Cost effectiveness of interventions for schizophrenia in Mexico. Salud Ment [online]. 2011, vol.34, n.2, pp.95-102. ISSN 0185-3325.

The World Health Organization estimates that the expense of attending mental illness problems in developed countries amounts to 3-4% out of the total GDP. The public expense for hospitalization of patients diagnosed with schizophrenia was three times higher in patients who decide to leave the treatment than those who continue with it; ambulatory patients amount to almost the same figures in public expenses whether they decide to continue the treatment or not. In the USA, there are 87 000 people hospitalized due to schizophrenia every year, which represent 93 000 hospital days with a cost of about 806 billion dollars a year; to stop patients from leaving the treatment, however, would cut the number of acute cases 12.3% and hospitalizations 13.1%. These two reductions would cut down the expenses in Medicaid as much as 106 million dollars. According to data gathered by the Organization for the Economical Cooperation and Development for Germany, the expense in mental health accounts for 10% of total health expenses, being schizophrenia, depression and anxiety the most costly illnesses. Finland doubled the expenses to attend those who suffered mental illnesses between 1990 and 2003. The total annual expenses for the treatment of schizophrenia in Latin American and Caribbean countries accounts for 1.81%, for Africa 0.47%, for Europe 1.32% and for southern Asia 0.52 in millions of dollars per every million people. In Mexico, a first estimate, based on the demand and the amount of money destined to attend this problem by every health institution, it was concluded that the average annual expenses in medical attention for schizophrenia was US97.54 per person. The Health Sector reports that the cost for a psychiatric evaluation or psychotherapy amounts to US1.42 and the estimated annual cost for the treatment of schizophrenia in a public institution amounts to somewhere between US60.34 and US2,1 86.83; all this would depend on the haloperidol or clozapine drug. In a private institution, the cost for a psychiatric evaluation is US63.44 and the annual estimated cost is somewhere between US1,695.79 and US5,988.58 including treatments with the aforementioned drugs. The cost-effectiveness analysis is a method which indentifies, quantifies and values the expenses of two or more alternatives of sanitary intervention available at the time to reach certain objectives. This will be possible as long as the effects are channeled to the same class of effects. The measure of the analysis summary concerning cost-effectiveness is the ratio cost-effectiveness which allows comparison of different action alternatives, identifying two types of indicators: average cost and increased cost. Regarding the methodological procedures, the research project was based in a length and descriptive study, though not statistical. It was designed to carry out an analysis of cost-effectiveness in the alternatives of treatment for patients who were diagnosed with schizophrenia at the Fray Bernardino Psychiatric Hospital. This study allowed the identification and quantification of costs of the demand, the treatment, hospitalization, and the ambulatory services. The effectiveness of the alternatives in treatment studied is measured in terms of the readmitted. Four non-statistical samples were taken of clinical files out of each studied service. External Consultation: 50 clinical files, 15 were discarded for not being diagnosed with schizophrenia; the other 35 were followed and analyzed for six months. Day Hospital: 65 files of the total of patients diagnosed with schizophrenia, 12 were discarded for being diagnosed differently. Therapeutic clinical adherence (TAC): a sample of 85 files of patients diagnosed with schizophrenia was taken. Patients with membership to ISSSTE diagnosed with schizophrenia who came out of hospitalization between June-October 2008 were followed during a period of six months in order to measure the readmitted to hospitalization; 67 patients were registered. The costs of personnel (doctor, nurses, social service, and psychology and hygiene staff) were obtained out of the coefficient of the total annual salary between the annual working day in minutes for the time destined to attention of each patient. The costs for catering and laundry were calculated directly. The laboratory cost was obtained taking into account cost-time destined to the study of administrative personnel, technicians and supervision, as well as materials and the necessary equipment. The indirect costs (security, hygiene, water, electric power, and municipal and biological waste) were obtained dividing the total annual costs in the average annual number of patients who needed hospitalization; this was done taking into account that the daily average in occupation is 296 patients. The external consultation was excluded for being deemed unimportant in terms of consumption. Analysis: descriptive statistics. Cost-effectiveness analysis. With respect to the main findings, the hospitalization costs are: emergency room US136.00, intensive care US1 62.72, and continuous hospitalization US68.83. The cost of day hospital is US34.57, US68.91 in TAC and external consultation US9.67. The semester consultation for patients undergoing external consultation, day hospital and TAC received 2.3, 23.5 and 7.5 each one. The readmitted in ambulatory services are 8.5%, 7.5%, and 5.8% for external consultation, day hospital, and TAC. The hospitalization days for patients who were readmitted due to an increase in symptoms was 42.5, 1 2.5, and 25 days in average for external consultation, day hospital and TAC. The effectiveness coefficient indicates that avoiding a readmitted to external consultation, day hospital, TAC and external consultation at ISSSTE amounted to US15.26, US518.84, US499.23 and US16.37 accordingly. The cost of making use of an additional hospital unit during the day is US 1321.41; it amounts to US11 66.31 for therapeutic care and US1 7.79 at ISSSTE. According to the main results, the costs for medical attention through the system of cascade primary costs differ too much when compared to the unitary costs published in the Diario Oficial; the ambulatory costs are very different in terms of costs but they show very similar results. The difference between the costs for attending patients diagnosed with schizophrenia is due to the number of patients and the personnel assigned to the area. These results are influenced by the number of semester consultations: 23.5 times in day care hospitalization against the 7.5 and 2.3 times in average of TAC and external consultation accordingly. The average rate of avoided readmitted is low in external consultation compared to the other three alternatives; this rate is affected by the largest number of people who abandoned TAC, which could empirically be explained by the need of the patient to buy his medication. Upon making a comparison of the costs of the alternatives of integral treatment for schizophrenia in the Fray Bernardino Psychiatric Hospital, we found that the average cost for external consultation is much clearer in terms of cost-effectiveness than day hospital and TAC; this means that the first option is much more effective and less money is required than the other two. Even though external consultation registers a very high rate of abandonment in terms of treatment by the patients, it still shows to be more effective. It is also slightly more effective than external consultation at ISSSTE; this is to say that if we only consider the effectiveness based on how much we avoid readmitted, it would be much more appropriate for patients who attend external consultation to be given the necessary medication and in doing so reducing the costs of day care hospitalization and TAC. The increased cost shows that avoiding an admitted to day hospital results in a cost of about US1321.41 which is almost the same as readmitted a patient attending external consultation whose symptoms have become more acute, and much more expensive than the total cost of attending that patient in that service over six months. The cost for avoiding a readmitted in TAC is US1166.31 whereas the cost for avoiding a readmitted in ISSSTE is US1 7.79 the strategy should be targeted to providing the necessary medication for patients who are attending external consultation.

Palabras llave : Schizophrenia; cost-effectiveness; readmitted.