R ESEA R C H & O PI N I ON

10

Economic burden of psychotic and learning disorders

Based on 1986 data. learning disorders.

schizophrenia and neurotic conditions. including

depression. are major economic burdens on the UK

National Health Service (NHS). say UK-based

investigators. In contrast, dementia and depression

in the elderly largely impact on the cost of soc ial

services [see table] . The 1986 NHS healthcare budget for patients with

psychotic disorders was £795.3 million fo r inpatient

care (includ ing drug costs), £20.9 million fo r

outpatient care (excluding drug costs) and 05.6 million

for day patients (excluding drug costs). For patients

with learn ing disorders, the respective values were

£460.1 million , £2.5 million and £5 .5 million .

Total expenditure o n general medical care was

calculated at £1134.5 million (excluding drug

costs).

Cost of psychotic and learning disorders in the UK in 1986 (£ millions) - NMS """" - -- SodoI ...... - "",w - -...... -' ,....-.... - 187.8 238> 11 .8 .... 328.'

SdolzcP .... Ia 323.' .... 0." 11.3 .... , -- 232J NA NA NA NA

, ...... '" -"- 184.8 184.0 ' .1 19.6 m ....-....... 532.0 230.0 ... 39.' ""'J -• IJokrItary groupII oontributirlg IinandIII ~ for the caN fA

peli«lts ........ It-.. dIOfdets ndudIcIlhe AIzheIrner"t, 0iMase SOciety,

.... Nalionll Sd'izophrerIiII Fin!, AgIo eono.m wo::I MENCAP .

•• The COlt fA ........ nodallon provided by !tie I)ItvaSa Mdof.

In regard to social service costs. it was esti mated

that elderly patients in the community with demen tia

or depression received 3.5 hours of home care/week

at a cost of £3 .50Ihour, and 2 meals/week at a cost

of £21meal [su table). These patients also received

care from social workers who visited every second

week. at a cost of £6/visit. Social work cost around

flO/week for patients with schizophrenia.

Smilh K. SIWI A. Wright K. le .... is G. eI a1 The fRVU,nce and tostll of

psychiauic disorders and kam,n, d,~b,';ties. Bmish Journal of l"JychialJ)l

166: 9-18. Jan 1995 .,10' ..

Cost considerations , , ,

• In a us hospital, oral ciproOoxacin alone resulted

in earlier dio;charge and lower hospitalisation costs,

compared with combination therapy with oral

ciprofloxacin and other IV or oral antibacterials or

conventional (nonquinolone) IV therapy in patients

with respiratory, urinary and skin infections. After

examining the medical records of 247 patients. the

researchers found no significant difference in the cure

rate for patients receiving conventional IV therapy or

oral ciprofloxacin ruonc. Notably, the duration of

21 JlLn 1 ~ F'HARM.*.CORESOURCES

treatment required for cure or improvement was

5.9 days for patients receiving oral ciprofloxacin

aJone. compared with 7.9 and 10.3 days for patients

receiving conventional rv and combination therapies.

respectively.

Lorian v , eI al. Oral cipot1ouc:iD venus ULInL>'tnouS therapy with 0Iher

non·quinol()l'£ ~nlll; • study of29! ;nf«uOM. Drup Under E~pcrilMntal

and C1inic:Il Re5UrCh 20: 2(l9·21". No.5. 1994 ..,.."

Lifetime costs of epilepsy

The tota! lifetime cost of epilepsy for newly­

diagnosed patients in the US in 1990 was estimated

al SUS3 billion·. wilh indirect costs representing

63% of this value, according to findings of a US

cost-of-illness study. The study authors developed a simulation model.

incorporating expert opinion and data from the

medical literalure, to calculate the direct and indirect

cos ts of care fo r the estimated 147000 new cases of

epilepsy in 1990. Patients were divided into 6

prognostic groups. based on the clinical course of

their condition . Direci costs addressed by the model included

those associated with hospital care, physician visits,

drug therapy, emergency hospital care, and major

diagnostic procedures. Indi rect costs included those

associated with morbidity (lost work. lost house­

keepi ng days. and excess unemployment) and

premature mortality.

Cost differences between prognostic groups

The average lifetime costipatient totaJled

SUS20 352. ranging f rom SUS4272/patien t with

permanent remission following initiaJ diagnosis

to SUS 138 602/non institutionalised patient with

frequent seizures. Furthermore. 50% of total lifetime

di rect costs were attribuled to the 15% of patients

with intractable epilepsy. The greatest proportion

of direct costs was associated with anticonvulsanl

therapy. followed by physician visits and hospitalisation.

Notably, nonin stitutionali sed patients with

frequent seizures accounted for a total lifetime

indirect cost of SUS 1.3 bi ll ion, SUS900 million

and SUS400 mi ll ion of wh ich were associated

with morbidity and premature mortality, respectively.

In contrast, < 5% of indirect costs were attributed

to patients with permanent remission following

initial diagnosis, say Ihe study authors.

However. they point out that these direct and

indirect costs are conservative estimates, as they

do not include additional expenses such as those

relating to the treatment of seizure-induced injuries,

denial care attributed to adverse effects of

anticonvu lsants. coun selling and lost employment

of caregivers, and reduced quality of life.

• 1990 dclfars

Belley CEo Annc,e:rs IF. I..ainon OR. Reynolds Tf. Hauser WA. et al. CO$(

of cpilcspy in the United StIleS: . model based 00 incidence and ~is.

Epilcpsia 35: 12JO.12A). Nov-Dec 1994

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