An Estimate of the Monthly Cost of Two Major Mental Disorders in an Indian Metropolis

Article excerpt

Byline: P. Sharma, S. Das, S. Deshpande

Background: The components of high cost of treating a chronic psychiatric illness are: long-term continuous treatment consisting of consultation and medication costs, traveling to the treatment centre and taking time off from work for both patient and caregiver. Apart from direct treatment costs, expenditure of time in care-giving results in indirect costs. All these costs are borne by families as the sufferer may be unable to work. Aim: To estimate the cost of treatment of chronically ill patients at home, in terms of the above parameters. Methods: The sample consisted of 117 subjects of either sex in the age range of 18 to 60 years, ill for at least one year, diagnosed as schizophrenia (n=95) or bipolar disorder (n=22, a comparison group) who agreed to participate in the study along with at least one caregiver. The tools used were the Diagnostic Interview of Genetic Studies and Economic Burden Questionnaire administered to both the subject and the caregiver. Results and conclusions: The costs of treatment were found to be high but with wide variations in the range. Costs for bipolar disorder were somewhat higher than those for schizophrenia at least for the period of study. Demographic differences between subjects and caregivers were present.

Introduction

The family has a significant role in the treatment and prognosis of mental illness of an individual. Initially the role was viewed as contributory in the aetiology of illness, whereas the focus of current research has shifted towards the understanding of the effect of mental illness on the family. Hoenig and Hamilton[1] pioneered the concept of objective and subjective burden experienced by family members of the mentally ill person and tried to differentiate between the two. The presence of a mentally ill person at home affects all family members, problems occur in the areas of health, recreational activities, social and marital relations, and above all finances. Families of psychiatric patients thus experience substantial burden which indicates the breakdown of reciprocal arrangements that people maintain in their relationships, such that one person is doing 'more than their fair share'.[2] A large majority of persons with mental illness either remain unemployed or underemployed which further adds to the financial burden of the families. In two different studies it was found that the financial burden experienced by the families were up to the extent of difficulty in visiting hospitals (58%, [3] 55% [4] ). In the 1960s, the shift from hospital- to community-based care was supposed to reduce the load on hospitals, help early recovery and prevent chronic handicap among mentally ill persons as well as effect substantial savings for indoor hospital care.[5] Many countries launched large-scale community mental health programmes without assessing the burden that the family had to face and possible effect on other family members.[6] So far only a few attempts have been made to assess the type and degree of burden placed on families of sufferers treated at home in India.

Although research on actual cost in treating widely prevalent diseases has appeared in medical literature,[7],[8],[9],[10],[11] less work has been carried out in India on economic burden of mental illness.[3],[12] While terms such as direct costs, indirect costs (quantified in India to some extent[3]) and soft costs[7] are used when healthcare economics is discussed, actual costs of mental illness have not been studied in detail. Direct costs involve cost of travelling, taking time off from work for both the patient (if employed) and caregiver, and cost of psychotropic drugs (long duration of treatment increases cost). Generic drugs may or may not cost less than the branded ones.[13],[14],[15]

The present study focused on the cost of chronic major mental illnesses to family and patient. One problem in carrying out such studies is difficulty in recollecting approximate expenses incurred on various treatment modalities, travel, cost of drugs, wages lost and other expenses from the very onset of the illness. …