Financial cost of treating Nigerian in-patients with schizophrenia

Fifty seven each ofhospitalised schizophrenic patients (fulfilled diagnostic criteria for research version of I.C.D. 10) and diabetic patients respectively, matched for age and sex, were followed up from admission to discharge (July 1997 - December 1997). B.P.R.S. was used to measure the severity of psychopathology at admission and discharge for the former, while the levels of blood glucose at admission and discharge were assessed for the latter. Also, interviewed during the study were 374 relatives comprising 102 and 272 relatives of schizophrenic and diabetic patients respectively. Weekly assessments of cost of treatment were done from admission to discharge using the proforma which took cognisance of aspects of direct and indirect costs for patients and relatives of both groups. Schizophrenic patients had a poorer employment record (P = 0.000), more diabetic patients were married (P = 0.000), relatives shouldered the financial burden of care of more schizophrenic patients (P = 0.000), more schizophrenic patients travelled over an average of 122 km to reach the hospital whereas diabetic patients travelled averagely 19.8 km (P = 0.000) and the mean duration of admission for schizophrenic patients was significantly longer (P = 0.000). The mean monthly income for diabetic patients was significantly higher than for schizophrenic patients (P = 0.000), and the mean direct cost for schizophrenia per admission 9882.00 Naira was significantly higher than that of diabetes mellitus 7892.00 Naira (P = 0.000). The mean indirect cost for schizophrenic patients per admission which is 3604.00 Naira did not differ significantly from that of diabetic patients of 1488.00 Naira (P = 0.288). The mean total cost of schizophrenia per admission--is 11,337.00 Naira and was significantly higher than for diabetes 8571.00 Naira (P = 0.000). However, the mean direct cost per week for diabetes mellitus 4494.00 Naira was significantly higher than for schizophrenia 1011.00 Naira (P = 0.00). The mean indirect cost for diabetes mellitus per week 406.00 Naira did not differ significantly from that ofschizophrenia 168.00 Naira (P = 0.602). The mean total cost of diabetes mellitus per week 4910.00 Naira was significantly higher than for schizophrenia 1235.00 Naira (P = 0.000). Cost of medication ranked highest in all items of cost for both the schizophrenic and diabetic cohorts. The implications of the findings on clinical practice in Nigeria and our current socio-economic scenario (especially with regard to schizophrenic patients and their families) are discussed. The need to reinforce the socio-economic support from government and the larger society for schizophrenic patients and their families is highlighted.