A COMPARATIVE STUDY ON ECONOMIC BURDEN BET\VEEN SCHIZOPHRENIA AND DIABETES MELLITUS IN MALAYSIAN SECONDARY HOSPITAL
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Date
2010-09
Authors
A.KADIR, NORAZLIN
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Abstract
The present study aimed to assess recent direct cost incurred for treating adult
schizophrenic patients in a secondary public hospital and compare it with a
comparison group of patients with diabetes mellitus, to compare several patient's
socio-demographic, clinical and treatment characteristics that influenced its' direct
costs, and to determine the factors associated with higher direct costs. A prospective
cohort study was conducted from March 2007 to November 2007 in Sultanah
Fatimah Specialist Hospital. Direct treatment ·casts of 75 adult out-patients with
schizophrenia was assessed over six months and compared with 61 adult diabetic
patients. The Mann-Whitney U test and Kruskal-Wallis test were used to compare
the differences in costs and a priori p value less than alpha value of 0.05 was
considered as statistically significant. The study revealed that schizophrenia is a
costly illness with hospital and total direct costs not significantly different with
diabetes mellitus. However, patient costs were significantly higher for treating
diabetes mellitus. For schizophrenia, the median hospital cost over six months was
RM 612.29 (RM 31.01 to RM 4,971.74), median patient cost (out of pocket
expenses): RM 66.00 (RM 10.50 to RM 529.00), and median total direct costs:
RM 646.61 (RM 41.51 to RM 5,500.74). The largest contributor of direct costs was
from hospital's perspective with 93% for schizophrenia and 75% for diabetes
mellitus. Drug and supplies was the largest contributor for hospital cost for both
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illnesses, 94.29% for schizophrenia and 77.00% for diabetes mellitus. Out of total
patient cost, majority was come from transportation (68.78%) for schizophrenia,
while other supplements and supplies (47.68%) for diabetes mellitus. For both
illnesses, high total number of visits to hospital incurred significantly higher direct
costs. Young schizophrenic adults aged 18 to 39 years and patients on atypical
antipsychotic drug at baseline had incurred significantly higher direct costs.
Meanwhile, presence of diabetes complication and patients prescribed with insulin or
combination of both insulin and oral hypoglycaemic agents incurred significantly
higher direct costs. For both illnesses, direct costs were associated with number of
visits to hospital over six months. Hence, schizophrenia is a costly illness to treat
with medications accounted a large proportion of total direct cost. Reducing number
of hospital visits for both illnesses is one of the strategies to reduce hospital and total
direct costs. Whether the use of more effective and expensive atypical antipsychotics
will decrease total costs also remains to be determined and studied.
Keywords: Schizophrenia, comparative study, diabetes mellitus, direct cost, outpatient,
secondary care, Malaysia.
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A COMPARATIVE STUDY ON ECONOMIC BURDEN