Skip to main content
×
×
Home

The difficult task of predicting the costs of community-based mental health care. A comprehensive case register study

  • V. Donisi (a1), J. Jones (a2), R. Pertile (a1), D. Salazzari (a1), L. Grigoletti (a1), M. Tansella (a1) and F. Amaddeo (a1)...
Abstract
Background.

Previous studies have attempted to forecast the costs of mental health care, using clinical and individual variables; the inclusion of ecological measures could improve the knowledge of predictors of psychiatric service utilisation and costs to support clinical and strategic decision-making.

Methods.

Using a Psychiatric Case Register (PCR), all patients with an ICD-10 psychiatric diagnosis, who had at least one contact with community-based psychiatric services in the Verona Health District, Northern Italy, were included in the study (N = 4558). For each patient, one year's total cost of care was calculated by merging service contact data with unit cost estimates and clinical and socio-demographic variables were collected. A socio-economic status (SES) index was developed, as a proxy of deprivation, using census data. Multilevel multiple regression models, considering socio-demographic and clinical characteristics of patients as well as socioeconomic local characteristics, were estimated to predict costs.

Results.

The mean annual cost for all patients was 2,606.11 Euros; patients with an ongoing episode of care and with psychosis presented higher mean costs. Previous psychiatric history represented the most significant predictor of cost (36.99% R2 increase) and diagnosis was also a significant predictor but explained only 4.96% of cost variance. Psychiatric costs were uniform throughout the Verona Health District and SES characteristics alone contributed towards less than 1% of the cost variance.

Conclusions.

For all patients of community-based psychiatric services, a comprehensive model, including both patients' individual characteristics and socioeconomic local status, was able to predict 43% of variance in costs of care.

Copyright
Corresponding author
*Address for correspondence: Dr V. Donisi, Ph.D., Psychologist, Section of Psychiatry and Clinical Psychology, Department of Public Health and Community Medicine, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy. (Email: valeria.donisi@univr.it)
References
Hide All
Amaddeo, F, Tansella, M (2009). Information systems for mental health. Epidemiologia e Psichiatria Sociale 18, 14.
Amaddeo, F, Bonizzato, P, Rossi, F, Beecham, J, Knapp, M, Tansella, M (1995). La valutazione dei costi delle malattie mentali in Italia: sviluppo di una metodologie e possibili applicazioni (Evaluating costs of mental illness in Italy: the development of a methodology and possible applications). Epidemiologia e Psichiatria Sociale 4, 145162.
Amaddeo, F, Beecham, J, Bonizzato, P, Fenyo, A, Knapp, M, Tansella, M (1997). The use of a case register to evaluate the costs of psychiatric care. Acta Psychiatrica Scandinavica 95, 189198.
Baca-Garcia, E, Perez-Rodrigues, M.M., Basurte-Villamor, I, Quintero-Gutierrez, FJ, Sevilla-Vicente, J, Martinez-Vigo, M, Artes-Rodriguez, A, Fernandez del Moral, AL, Jimenez-Arriero, MA, Gonzalez de Rivera, JL (2008). Patterns of mental health service utilization in a general hospital and outpatient mental health facilities: analysis of 365,262 psychiatric consultations. European Archives of Psychiatry and Clinical Neuroscience 258, 117123.
Beecham, J, Hallam, A, Knapp, M, Baines, B, Fenyo, A, Ashbury, M (1997). Costing care in the hospital and the community. In Care in the community; illusion or reality? (ed. Leff, J.), pp. 93108. John Wiley and Sons: Chichester.
Caranci, N, Costa, G (2009). Un indice di deprivazione a livello aggregato da utilizzare su scala nazionale: giustificazioni e composizione. Salute & Società 8, 5878.
Carr, VJ, Neil, AL, Halpin, SA, Holmes, S, Lewin, TJ (2003). Costs of schizophrenia and other psychoses in urban Australia: findings from the Low Prevalence (Psychotic) Disorders Study. Australian and New Zealand Journal of Psychiatry 37, 3140.
Cochran, WG (1977). Sampling Techniques. Wiley: Toronto.
Curtis, S, Copeland, A, Fagg, J, Congdon, P, Almog, M, Fitzpatrick, J (2006). The ecological relationship between deprivation, social isolation and rates of hospital admission for acute psychiatric care; a comparison of London and New York City. Health and Place 12, 1937.
Drukker, M, Gunther, N, VanOs, J (2007). Disentangling associations between poverty at various levels of aggregation and mental health. Epidemiologia e Psichiatria Sociale 16, 39.
Egon (2009). Retrieved 18 June 2009 from http://www.wareplace.it/.
Ginsberg, G, Lerner, Y, Mark, M, Popper, M (1997). Prior hospitalization and age as predictors of mental health resource utilization in Israel. Social Science and Medicine 44, 623633.
Grigoletti, L, Amaddeo, F, Grassi, A, Boldrini, M, Chiappelli, M, Percudani, M, Catapano, F, Fiorillo, A, Perris, F, Bacigalupi, M, Albanese, P, Simonetti, S, De Agostini, P, Tansella, M, I-PSYCOST Group (2010). A predictive model to allocate frequent service users of community-based Mental Health Services to different packages of care. Epidemiologia e Psichiatria Sociale 19, 168177.
ISTAT (2001). XIV Censimento della Popolazione e delle Abitazioni. Istituto Poligrafico e Zecca dello Stato: Roma.
Jones, J, Amaddeo, F, Barbui, C, Tansella, M (2007). Predicting costs of mental health care: a critical literature review. Psychological Medicine 37, 467–77.
Knapp, M, Chisholm, D, Leese, M, Amaddeo, F, Tansella, M, Schene, A, Thornicroft, G, Vazquez-Barquero, JL, Knudsen, HC, Becker, T, EPSILON. European Psychiatric Services: Inputs Linked to Outcome Domains and Needs (2002). Comparing patterns and costs of schizophrenia care in five European countries: the EPSILON study. Acta Psychiatrica Scandinavica 105, 4254.
Mangalore, R, Knapp, M (2007). Cost of schizophrenia in England. Journal of Mental Health Policy and Economics 10, 2341.
McCrone, P, Thornicroft, G, Parkman, S, Nathaniel-James, D, Ojurongbe, W (1998). Predictors of mental health service costs for representative cases of psychosis in south London. Psychological Medicine 28, 159164.
McDaid, D, Knapp, M, Curran, C, The MHEEN Group (2006). Meeting the challenge of funding and allocating resources to mental health across Europe: developing the Mental Health Economics European Network. Epidemiologia e Psichiatria Sociale 15, 117122.
Mirandola, M, Amaddeo, F, Dunn, G, Tansella, M (2004). The effect of previous psychiatric history on the cost of care: a comparison of various regression models. Acta Psychiatrica Scandinavica 109, 132139.
Searle, SR, Casella, G, McCulloch, CE (1992). Variance Components. Wiley: New York.
Stata Corporation (2005). Stata Statistical Software: Release 9. Stata Corporation LP: College Station, TX.
Tansella, M, Bisoffi, G, Thornicroft, G (1993). Are social deprivation and psychiatric service utilisation associated in neurotic disorders? A case register study in south Verona. Social Psychiatry and Psychiatric Epidemiology 28, 225230.
Tansella, M, Micciolo, R, Biggeri, A, Bisoffi, G, Balestrieri, M (1995). Episodes of care in first-ever psychiatric patients. A long term case-register evaluation in a mainly urban area. British Journal of Psychiatry 167, 220227.
Tansella, M, Amaddeo, F, Burti, L, Lasalvia, A, Ruggeri, M (2006). Evaluating a community-based mental health service focusing on evere mental illness. The Verona experience. Acta Psychiatrica Scandinavica 113 (Suppl. 429), 9094.
Tello, JE, Mazzi, M, Tansella, M, Bonizzato, P, Jones, J, Amaddeo, F (2005 a). Does socioeconomic status affect the use of community-based psychiatric services? A South Verona case register study. Acta Psychiatrica Scandinavica 112, 215223.
Tello, JE, Jones, J, Bonizzato, P, Mazzi, M, Amaddeo, F, Tansella, M (2005 b). A census-based socio-economic status (SES) index as a tool to examine the relationship between mental health services use and deprivation. Social Science and Medicine 61, 20962105.
Thornicroft, G, Bisoffi, G, De Salvia, D, Tansella, M (1993). Urban rural differences in the association between social deprivation and psychiatric service utilization in schizophrenia and all diagnoses: a case-register study in Northern Italy. Psychological Medicine 23, 487496.
Tiainen, A, Edman, G, Flyckt, L, Tomson, G, Rehnberg, C (2008). Regional variations and determinants of direct psychiatric costs in Sweden. Scandinavian Journal of Public Health 36, 483492.
World Health Organisation (WHO) (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Description and Diagnostic Guidelines. WHO: Geneva.
World Health Organisation (WHO) (2000) World Health Organisation CHOosing Interventions that are Cost Effective (WHO-CHOICE). Retrieved 25 April 2011 from http://www.who.int/choice/costs/en/.
Zulian, G, Donisi, V, Secco, G, Pertile, R, Tansella, M, Amaddeo, F (2011 in press). How are caseload and service utilisation of psychiatric services influenced by distance? A geographical approach to the study of community-based mental health services. Social Psychiatry and Psychiatric Epidemiology [26 June 2010;Epub ahead of print]
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Epidemiology and Psychiatric Sciences
  • ISSN: 2045-7960
  • EISSN: 2045-7979
  • URL: /core/journals/epidemiology-and-psychiatric-sciences
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed