Epidemiology and Psychiatric Sciences

Original Articles

The difficult task of predicting the costs of community-based mental health care. A comprehensive case register study

V. Donisia1 c1, J. Jonesa2, R. Pertilea1, D. Salazzaria1, L. Grigolettia1, M. Tansellaa1 and F. Amaddeoa1

a1 Section of Psychiatry and Clinical Psychology, Department of Public Health and Community Medicine, University of Verona, Verona, Italy

a2 Department of Mental Health and Learning Disability, City University, London, UK

Abstract

Background. Previous studies have attempted to forecast the costs of mental health care, using clinical and individual variables; the inclusion of ecological measures could improve the knowledge of predictors of psychiatric service utilisation and costs to support clinical and strategic decision-making.

Methods. Using a Psychiatric Case Register (PCR), all patients with an ICD-10 psychiatric diagnosis, who had at least one contact with community-based psychiatric services in the Verona Health District, Northern Italy, were included in the study (N = 4558). For each patient, one year's total cost of care was calculated by merging service contact data with unit cost estimates and clinical and socio-demographic variables were collected. A socio-economic status (SES) index was developed, as a proxy of deprivation, using census data. Multilevel multiple regression models, considering socio-demographic and clinical characteristics of patients as well as socioeconomic local characteristics, were estimated to predict costs.

Results. The mean annual cost for all patients was 2,606.11 Euros; patients with an ongoing episode of care and with psychosis presented higher mean costs. Previous psychiatric history represented the most significant predictor of cost (36.99% R2 increase) and diagnosis was also a significant predictor but explained only 4.96% of cost variance. Psychiatric costs were uniform throughout the Verona Health District and SES characteristics alone contributed towards less than 1% of the cost variance.

Conclusions. For all patients of community-based psychiatric services, a comprehensive model, including both patients' individual characteristics and socioeconomic local status, was able to predict 43% of variance in costs of care.

(Received March 23 2011)

(Revised May 04 2011)

(Accepted May 05 2011)

Correspondence

c1 Address for correspondence: Dr V. Donisi, Ph.D., Psychologist, Section of Psychiatry and Clinical Psychology, Department of Public Health and Community Medicine, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy. (Email: valeria.donisi@univr.it)