Costs of treating patients with psychosis change significantly as they age

December 12, 2016

Treating psychotic illnesses cost the province of Ontario, Canada just under $2.1 billion in 2012, which was about four per cent of the total provincial health budget, according to a new study from the Institute for Clinical Evaluative Sciences (ICES) and Centre for Addiction and Mental Health (CAMH). But even more striking, according to the researchers, is how health-care costs for patients with psychotic disorders changed as they aged.

Chronic psychotic disorders, such as schizophrenia, are severe and disabling, and are associated with poor psychiatric and medical outcomes. These disorders are considered one of the most costly mental illnesses due to the young age at onset and the need for intensive over the patient's lifetime.

"We already knew costs for treating psychotic illnesses were high, but what this study shows is how early start incurring long-term care costs. Patients with psychotic illnesses as young as 46 are in long-term care facilities, which is very young," says Dr. Claire de Oliveira, author of the study and scientist at both ICES and CAMH's Institute for Mental Health Policy Research.

Individuals with chronic psychotic illnesses also have complex medical needs related to their physical health, which accounted for the change in health care costs with age. In younger patients, the majority of health care costs were associated with psychiatric hospitalizations. As patients aged, long-term care and medical hospitalizations accounted for a greater share of total health care costs, suggesting the development of different health care needs over time.

"These findings highlight the need to address both physical and simultaneously in younger patients to avoid more serious conditions from developing, and to manage the comorbidity in older patients," adds de Oliveira.

The study found there were 142,821 patients over the age of 15 with a chronic psychotic illness (roughly 1.2 per cent of the total population) in Ontario in 2012 with an average age of 49. Among this group, most lived in low-income, urban neighbourhoods. Roughly 17 per cent had a psychiatric hospitalization in the year of analysis, with an average of two hospitalizations and average length of stay of 49 days.

The study also found that younger patients with psychosis had five to nine times higher health care costs associated with psychiatric hospitalizations in that year, compared with the health care costs of young people without psychosis (for males 16-25: $10,283; for females 16-25: $7,310 compared to young people without psychosis who on average cost about $1,112 for males and $1,621 for females).

The over 65 age group had the highest costs overall. More than half their health care costs were associated with long-term care and medical hospitalizations (for males 65+: $29,249; for females 65+: $26,788 compared to males 65+: $12,095, females 65+: $12,673 without psychosis).

"Our results suggest that the needs of patients with chronic psychotic illnesses change over time, and that those needs become more complex as people age. This complexity is reflected in the high and diverse health care costs in our older patients," says Dr. Paul Kurdyak, co-author and scientist at both ICES and CAMH, where he is also Medical Director of Performance Improvement. Dr. Kurdyak is also Director of Health Outcomes at the Medical Psychiatry Alliance.

The direct included costs associated with hospitalizations; emergency department visits; physician services and diagnostics tests; outpatient prescription drugs for individuals covered under the Ontario Drug Benefit program; home care; long-term care; and other care (this includes other ambulatory care, such as same-day surgery/procedures, cancer and dialysis clinics; other hospital-based care, such as rehabilitation and complex continuing care; and assistive devices). It did not include costs for addiction services.

This research is supported in part by the Medical Psychiatry Alliance (MPA), a collaborative health partnership of the Centre for Addiction and Mental Health, the Hospital for Sick Children, Trillium Health Partners, the University of Toronto, the Ontario Ministry of Health and Long-Term Care and an anonymous donor.

"Estimating the economic burden of chronic psychotic disorders in Ontario: a prevalence-based cost of illness study," was published today in The Journal of Mental Health Policy and Economics.

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