Economic Impact of Schizophrenia from a Hospital and Social Security System Perspective in Italy

Abstract

Background

Schizophrenia is one of the mental disorders with the highest economic and social costs, with an important burden on patients, caregivers, and society.

Objective

The objective of this study was to estimate the direct and social security costs of schizophrenia in Italy. As far as direct costs are concerned, those related to hospitalizations and pharmaceutical expenditure have been analyzed, while disability benefits (DBs) and incapacity pensions (IPs) have been considered for the social security costs.

Methods

In order to provide annual economic burden of schizophrenia using the real-world data, we analyzed the main regional and national databases related to hospitalizations and pharmaceuticals. Hospitalizations have been analyzed considering the Hospital Information System, which collects all the information regarding hospital discharges from all public and private hospitals (psychiatric wards or residential facilities have not been considered). Hospitalizations with a discharge date between 2009 and 2016, and with a primary or secondary diagnosis of schizophrenia (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 295.xx) were selected. Hospital costs have been estimated considering the national tariffs associated with each selected hospitalization. In addition, using the same inclusion criteria, the average DBs (for workers with reduced working capacity) and IPs (for workers without working capacity) provided each year have been analyzed from the social security benefit applications database. The estimate of pharmaceutical expenditure was prepared based on the OsMed 2018 Report (Italian Medicines Agency, latest issue 18 July 2019). A one-way deterministic sensitivity analysis was conducted to examine the robustness of the results.

Results

In Italy from 2009 to 2016, schizophrenia had an important economic impact from a social perspective. On average, 13,800 patients were hospitalized, with an average of 2.98 hospitalizations per patient. From a National Health Service (NHS) perspective and with specific reference to hospitalizations, the annual economic burden was €101.4 million, with an average cost per patient of €7338. On the other hand, pharmaceutical expenditure amounts to over €147 million each year, while residential, semi-residential, and specialist facilities amount to approximately €1 billion. Again, schizophrenia led to approximately 15,000 recipients of social security benefits (DBs and IPs) yearly from 2009 to 2015, with an average annual expenditure of €160.1 million (average cost per patient = €10,675).

Conclusions

Our study estimates an economic burden of schizophrenia of €1250 million per year in direct costs, of which 20% is related to hospitalizations and pharmaceutical expenditure. With regard to social security benefits, an average annual expenditure of €160.1 million was calculated (average cost per patient = €10,675).

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Fig. 1

Source: Hospital discharge forms data processing

Fig. 2

Source: Hospital discharge forms data processing

Fig. 3

Source: Istituto Nazionale Previdenza Sociale (INPS; National Social Security Institute) data processing

Fig. 4

Source: Personal processing

Fig. 5

Source: Personal processing

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Correspondence to Francesco Saverio Mennini or Andrea Marcellusi.

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Funding

This paper was implemented by unconditional support of Angelini SpA.

Conflict of Interest

Mennini Francesco Saverio, Gazzillo Simone, Nardone Claudia, Sciattella Paolo, Marcellusi Andrea, Migliorini Raffaele, Trabucco Aurilio Marco, Amore Mario, and Brugnoli Roberto have no conflicts of interest to declare.

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The data that support the findings of this study are available from the INPS, but restrictions apply to the availability of these data, which were used under license for the current study and are therefore not publicly available. Data are however available from the authors upon reasonable request and with permission of the INPS.

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Mennini, F.S., Marcellusi, A., Gazzillo, S. et al. Economic Impact of Schizophrenia from a Hospital and Social Security System Perspective in Italy. Clin Drug Investig 41, 183–191 (2021). https://doi.org/10.1007/s40261-020-00991-7

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