Research Article| Volume 19, ISSUE 1, P128-138, January 1997

Economic outcomes and costs in the treatment of schizophrenia

  • Martin Knapp
    Address correspondence to: Martin Knapp, MSc, PhD, Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, United Kingdom
    Personal Social Services Research Unit, London School of Economics and Political Science, London U.K.

    Centre for the Economics of Mental Health, The Institute of Psychiatry, London U.K.
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  • Shane Kavanagh
    Personal Social Services Research Unit, London School of Economics and Political Science, London U.K.

    Personal Social Services Research Unit, University of Kent at Canterbury, Canterbury, United Kingdom
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      Schizophrenia is an expensive illness, with hospitalization representing a major cost of treatment. To evaluate new drugs and management strategies for schizophrenia, we must have reliable measures of outcomes and costs. Cost-outcome evaluations are particularly important because they allow comparisons of the potential costs and consequences of various strategies. The best estimates of outcome use batteries of instruments to score the well-being of patients and their caregivers. Dimensions of well-being include clinical status, functional status, access to resources and opportunities, subjective quality of life, family well-being, and patient satisfaction with services. The best overall outcome may involve trade-offs between different dimensions (eg, moving a patient from hospital-based care to community-based care may improve the patient's quality of life but increase family burden). Although measuring direct costs of schizophrenia is reasonably straightforward, indirect costs are more difficult to measure. The cost of pain and suffering (intangible costs) caused by schizophrenia for an individual patient or family is seldom assessed, although quality-of-life measures may provide some information. Increased costs of treatments in one area (eg, medication) may well be offset by reduced expenditures in another (eg, hospitalization). Trade-offs between different dimensions and different schizophrenia management agencies are only possible once the boundaries between these have been made clear by proper economic evaluations


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        • Foster K
        • Meltzer H
        • Gill B
        • Hinds K
        OPCS Surveys of Psychiatric Morbidity Report 8: Adults with a Psychotic Disorder Living in the Community. Her Majesty's Stationery Office, London, UK1996
        • Shepherd M
        • Watt D
        • Falloon I
        • Smeeton N
        The natural history of schizophrenia: A five year follow up study of outcome and prediction in a representative sample of schizophrenics.
        Psychological Medicine: Monograph Supplement 15. Cambridge University Press, Cambridge, UK1989
        • Scottish Schizophrenia Research Group
        The Scottish first episode schizophrenia study VIII. Five-year follow-up: Clinical and psychosocial findings.
        Br J Psychiatry. 1993; 161: 496-500
        • Prudo R
        • Blum HM
        Five-year outcome and prognosis in schizophrenia: A report from the London field research centre of the international pilot study of schizophrenia.
        Br J Psychiatry. 1987; 150: 345-354
        • Leff J
        • Sartorius N
        • Jablensky AJ
        • et al.
        The international pilot study of schizophrenia: Five-year follow-up findings.
        Psychol Med. 1992; 22: 131-145
        • Allebeck P
        Schizophrenia: A life-shortening disease.
        Schizophr Bull. 1989; 15: 81-89
      1. (Department of Health)The Health of the Nation, Key Area Handbook: Mental Illness. Department of Health, London, UK1993
        • Lehman AF
        • Thompson JW
        • Dixon LB
        • Scott JE
        Schizophrenia: Treatment outcomes research—editors' introduction.
        Schizophr Bull. 1995; 21: 561-566
        • Meltzer H
        • Gill B
        • Pettigrew M
        • Hinds K
        OPCS Surveys of Psychiatric Morbidity Report 4: The Prevalence of Psychiatric Morbidity Among Adults Living in Institutions. Majesty's Stationery Office, London, UK1996
        • Lelliot P
        • Audini B
        • Knapp MRJ
        • Chisholm D
        The mental health residential care study. Classification of facilities and description of services.
        Br J Psychiatry. 1996; 169: 139-147
        • Rupp A
        • Keith SJ
        The costs of schizophrenia.
        Psychiatr Clin North Am. 1993; 16: 413-423
      2. National Health Service Executive.
        Burdens of Disease: A Discussion Document. National Health Service Executive, London, UK1996
        • Rice DP
        • Kelman S
        • Miller LS
        • et al.
        The Economic Costs of Alcohol and Drug Abuse and Mental Illness. National Institute of Mental Health, Rockville, Md1985
        • Evers SMAA
        • Ament AJHA
        Costs of schizophrenia in the Netherlands.
        Schizophr Bull. 1995; 21: 141-153
        • Andrews G
        • Hall W
        • Goldstein G
        • et al.
        The economic costs of schizophrenia: Implications for public policy.
        Arch Gen Psychiatry. 1985; 42: 537-543
        • Knapp MRJ
        The economic perspective: Framework and principles.
        in: Knapp MRJ The Economic Evaluation of Mental Health Care. Arena, Aldershot, UK1995: 1-26
        • Knapp MRJ
        Economic evaluations and interventions for children and adolescents with mental health problems.
        J Child Psychol Psychiatry. 1996; 38: 3-25
        • Kavanagh SM
        • Stewart A
        Economic evaluation of mental health care: Modes and methods.
        in: Knapp MRJ The Economic Evaluation of Mental Health Care. Arena, Aldershot, UK1995: 27-60
        • Conway M
        • Melzer D
        • Shepherd G
        • Troop P
        A Companion to Purchasing Adult Mental Health Services. Anglia and Oxford Regional Health Authority, Milton Keynes, UK1994
        • Culyer AJ
        The nature of the commodity “health care” and its efficient allocation.
        Oxf Econ Papers. 1971; 23: 189-211
        • Opit LJ
        The measurement of health service outcomes.
        in: Holland WW Detels R Knox G 2nd ed. Oxford Textbook of Public Health: Applications in Public Health. 3. Oxford Medical Publications, Oxford, UK1988: 159-172
        • Grad J
        • Sainsbury P
        The effects that patients have on their families in a community care and a control psychiatric service: A two year follow up.
        Br J Psychiatry. 1968; 114: 265-278
        • Kavanagh SM
        • Opit LJ
        • Knapp MRJ
        • Beecham JK
        Schizophrenia: Shifting the balance of care.
        Soc Psychiatry Psychiatr Epidemiol. 1995; 30: 206-212
        • Kavanagh SM
        • Opit LJ
        Estimating the prevalence of schizophrenia: A model for service development and evaluation. University of Kent, Canterbury, UK1995 (Discussion paper 953, Personal Social Services Research Unit)
        • MILMIS Project Group
        Monitoring Inner London Mental Illness Services.
        Psychiatr Bull. 1995; 19: 276-280
        • Tudor-Hart J
        The inverse care law.
        Lancet. 1971; 1: 405-412
        • Coid J
        Failure in community care: Psychiatry's dilemma.
        BMJ. 1994; 308: 805-806
        • Grounds A
        The Perrie lecture: The mentally disordered in prison.
        Prison Service Journal. 19901991; (Winter): 29-39
        • Melzer D
        • Hale AS
        • Malik SJ
        • et al.
        Community care for patients with schizophrenia one year after hospital discharge.
        BMJ. 1991; 303: 1023-1026
        • Redmayne S
        • Klein R
        • Day P
        Sharing Our Resources: Purchasing and Priority-setting in the NHS. National Association of Health Authorities and Trusts, Birmingham, UK1993
        • Glennerster H
        General practitioner fund-holding and mental health care. Rutgers University, New Brunswick, NJ1996 (Presented at a workshop on mental health service contracting)
        • Kavanagh SM
        • Knapp MRJ
        Market rationales, rationing and rationality: Mental health care reform in the United Kingdom.
        Health Aff. 1995; 14: 260-268