Cost evaluation of chronic schizophrenic patients during the first 3 years after the first contact

This study was performed in Italy, where mental health care is largely provided by the Government-financed Italian National Health Service (INHS). Since 1978, outpatient services and psychiatric beds in general hospitals have replaced psychiatric hospitals, which have not been permitted to admit new patients. The direct costs of three cohorts of 20 chronic schizophrenic patients were evaluated according to incidence data for a 3-year period. The analysis focused in particular on services provided by public institutions. The average cost per patient during this period following first contact-admission was $9,612 (1989 U.S. dollars), which is low compared to costs in other countries. The cost distribution between inpatient and outpatient services was different from other studies and showed that, in Italy, hospital expenses covered approximately 50 percent of total direct INHS costs. The length of time between onset and first contact-admission showed a significant association (p less than 0.01) with INHS costs during the 3 years. A significant association (p less than 0.05) also was found between the Scale for the Assessment of Positive Symptoms (SAPS) global symptom "delusions" evaluated after 5 to 7 years and the average INHS costs during the 3 years of the study.