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The economic burden of schizophrenia in Germany: A population-based retrospective cohort study using genetic matching

Published online by Cambridge University Press:  15 April 2020

S. Frey
S. Frey*
Affiliation:
Hamburg Center for Health Economics (HCHE), University of Hamburg, Hamburg Esplanade 36, 20354Hamburg, Germany
*
*Tel.: +49 40 428 38–8042; fax: +49 40 428 38–8043. E-mail address: [email protected].
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Abstract

Objective

Prior studies to determine the economic consequences of schizophrenia have largely been undertaken in clinical settings with a small number of cases and have been unable to analyze effects across different age cohorts. The aim of this study is to investigate the burden of schizophrenia in Germany.

Methods

Costs, service utilization, and premature mortality attributable to schizophrenia were estimated for the year 2008 using a retrospective matched cohort design. Therefore, 26,977 control subjects as well as 9411 individuals with a confirmed diagnosis of schizophrenia were drawn from a sickness fund claims database. To reduce conditional bias, the non-parametric genetic matching method was employed.

Results

The final study population comprised 8224 matched pairs. The annual cost attributable to schizophrenia was €11,304 per patient from the payers’ perspective and €20,609 from the societal perspective with substantial variations among age groups: direct medical expenses were highest among patients aged > 65 years, whereas younger individuals (< 25 years) incurred the greatest non-medical costs. The annual burden of schizophrenia from the perspective of German society ranges between €9.63 billion and €13.52 billion.

Conclusion

There are considerable differences in the distribution of costs and service utilization for schizophrenia. Because schizophrenia is characterized by an early age of onset and a long duration, research efforts should be targeted at particular populations to obtain the most beneficial outcomes, both clinically and economically.

Keywords

SchizophreniaBurden of diseaseHealth economicsAdministrative dataGenetic matchingRetrospective cohort study
Type
Original article
Information
European Psychiatry , Volume 29 , Issue 8 , October 2014 , pp. 479 - 489
Copyright
Copyright © Elsevier Masson SAS 2014

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References

Aakvik, A.Bounding a matching estimator: the case of a norwegian training program. Oxf Bull Econ Stat 2001;63:115–143.CrossRefGoogle Scholar
Abadie, A.Bootstrap tests for distributional treatment effects in instrumental variable models. J Am Stat Assoc 2002;97:284–292.CrossRefGoogle Scholar
Akobundu, E., Ju, J., Blatt, L., Mullins, C.D.Cost-of-illness studies: a review of current methods. Pharmacoeconomics 2006;24:869–890.CrossRefGoogle ScholarPubMed
Austin, P.C.A critical appraisal of propensity-score matching in the medical literature between 1996 and 2003. Stat Med 2008;27:2037–2049.CrossRefGoogle ScholarPubMed
Austin, P.C.Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med 2009;28:3083–3107.CrossRefGoogle ScholarPubMed
Austin, P.C.Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat 2011;10:150–161.CrossRefGoogle ScholarPubMed
Awad, A.G., Voruganti, L.N.P.The burden of schizophrenia on caregivers: a review. Pharmacoeconomics 2008;26:149–162.CrossRefGoogle ScholarPubMed
Bartels, S.J., Clark, R.E., Peacock, W.J., Dums, A.R., Pratt, S.I.Medicare and medicaid costs for schizophrenia patients by age cohort compared with costs for depression, dementia, and medically ill patients. Am J Geriatr Psychiatry 2003;11:648–657.CrossRefGoogle ScholarPubMed
Busse, R., Riesberg, A.Health care systems in transition: Germany. Copenhagen: WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies; 2004.Google Scholar
Caliendo, M., Hujer, R., Thomsen, S.L.The Employment Effects of Job Creation Schemes in Germany: A Microeconometric Evaluation. In: Millimet, D.Smith, J.Vytlacil, E.Estimating and Evaluating Treatment Effects in Econometrics. Advances in Econometrics Vol. 21 2008. p. 383–430.Google Scholar
Cochran, W.G., Rubin, D.B.Controlling bias in observational studies: a review. Sankhyā Indian J Stat Series A (1961–2002) 1973;35:417–446.Google Scholar
Committee for Rating Panel Doctors’ Services Ergänzungen/Änderungen zum Beschluss des Erweiterten Bewertungsausschusses zur Neuordnung der vertragsärztlichen Vergütung im Jahr 2009 vom 27./28. August 2008. Deutsches Ärzteblatt 2008;105:A1988–A1998.Google Scholar
Dehejia, R.H., Wahba, S.Propensity score-matching methods for non-experimental causal studies. Rev Econ Stat 2002;84:151–161.CrossRefGoogle Scholar
German Hospital Federation (Eds.), 2009. Anlage 1 zum DKG-Rundschreiben Nr. 99/2009 vom 27.03.2009. www.dkgev.de/media/file/5776.Anlage_1.pdf (accessed: 2014/04/06).Google Scholar
Diamond, A., Sekhon, J.S.Genetic matching for estimating causal effects: a general multivariate matching method for achieving balance in observational studies. Rev Econ Stat 2013;95:932–945.CrossRefGoogle Scholar
DiPrete, T.A., Gangl, M.Assessing bias in the estimation of causal effects: Rosenbaum bounds on matching estimators and instrumental variables estimation with imperfect instruments. Soc Methodol 2004;34:271–310.CrossRefGoogle Scholar
Elixhauser, A., Steiner, C., Harris, D.R., Coffey, R.M.Comorbidity measures for use with administrative data. Med Care 1998;36:8–27.CrossRefGoogle ScholarPubMed
Farley, J.F., Harley, C.R., Devine, J.W.A comparison of comorbidity measurements to predict healthcare expenditures. Am J Manag Care 2006;12:110–119.Google ScholarPubMed
Federal Statistical Office, Gesundheitsausgabenrechnung. Bonn: Federal Statistical Office; 2008.Google Scholar
Federal Statistical Office, Entwicklung der Bruttoverdienste. Wiesbaden: Federal Statistical Office; 2008.Google Scholar
Friemel, S., Bernert, S., Angermeyer, M.C., König, H-H.The direct costs of depressive disorders in Germany – Results from the European study of the epidemiology of mental disorders [German]. Psychiatr Prax 2005;32:113–121.CrossRefGoogle Scholar
Gardner, J.W., Sanborn, J.S.Years of potential life lost (YPLL) – what does it measure?. Epidemiology 1990;1:322–329.CrossRefGoogle ScholarPubMed
von der Schulenburg, J.-M. Graf, Greiner, W., Jost, F., Klusen, N., Kubin, M., Leidl, R.et al.German recommendations on health economic evaluation: third and updated version of the Hanover consensus. Value Health 2008;11:539–544.CrossRefGoogle Scholar
Grieve, R., Sekhon, J.S., Hu, T., Bloom, J.R.Evaluating health care programs by combining cost with quality of life measures: a case study comparing capitation and fee for service. Health Serv Res 2008;43:1204–1222.CrossRefGoogle ScholarPubMed
Häfner, H., an der Heiden, W., Buchholz, W., Bardens, R., Klug, J., Krumm, B.Organization and cost-effectiveness of complementary care for schizophrenic patients [German]. Nervenarzt 1986;57:214–226.Google Scholar
Heckmann, M., Kettner, A., Rebien, M.Offene Stellen im IV. Quartal 2008: Einbruch in der Industrie – Soziale Berufe legen zu. IAB-Kurzbericht, 11/2009. Nürnberg: Institut für Arbeitsmarkt- und Berufsforschung (IAB) der Bundesagentur für Arbeit; 2009.Google Scholar
Heider, D., Bernert, S., König, H.-H., Matschinger, H., Hogh, T., Brugha, T.S.et al.Direct medical mental health care costs of schizophrenia in France. Germany and the United Kingdom – Findings from the European Schizophrenia Cohort (EuroSC). Eur Psychiatry 2009;24:216–224.CrossRefGoogle Scholar
Hoffmann, F., Icks, A.Structural differences between health insurance funds and their impact on health services research: results from the bertelsmann health-care monitor [German]. Das Gesundheitswesen 2011;74:291–297.CrossRefGoogle Scholar
Holland, P.W.Statistics and causal inference. J Am Stat Assoc 1986;81:945–960.CrossRefGoogle Scholar
Honeycutt, A.A., Segel, J.E., Hoerger, T.J., Finkelstein, E.A.Comparing cost-of-illness estimates from alternative approaches: an application to diabetes. Health Serv Res 2009;44:303–320.CrossRefGoogle ScholarPubMed
Imai, K., King, G., Stuart, E.A.Misunderstandings between experimentalists and observationalists about causal inference. J R Stat S Series A (Statistics in Society) 2008;171:481–502.CrossRefGoogle Scholar
Imbens, G.W.Non-parametric estimation of average treatment effects under exogeneity: a review. Rev Econ Stat 2004;86:4–29.CrossRefGoogle Scholar
Institute for quality efficiency in health care (IQWiG) Working paper: cost estimation. Köln: IQWiG; 2009.Google Scholar
Kilian, R., Roick, C., Matschinger, H., Bernert, S., Mory, C., Angermeyer, M.C.The analysis of cost structures of the treatment of schizophrenia by means of standardized assessment instruments [German]. Psychiatr Prax 2001;28:102–108.CrossRefGoogle Scholar
Kilian, R., Roick, C., Angermeyer, M.C.The impact of the study design and the sampling procedure on the assessment of mental health service costs [German]. Der Nervenarzt 2003;74:561–570.CrossRefGoogle Scholar
Kleine-Budde, K., Müller, R., Kawohl, W., Bramesfeld, A., Moock, J., Rössler, W.The cost of depression – A cost analysis from a large database. J Affect Disord 2013;147:137–143.CrossRefGoogle ScholarPubMed
Knapp, M., Mangalore, R., Simon, J.The global costs of schizophrenia. Schizophr Bull 2004;30:279–293.CrossRefGoogle ScholarPubMed
König, H.-H., Friemel, S.Gesundheitsökonomie psychischer Krankheiten. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 2006;49:46–56.CrossRefGoogle Scholar
Konnopka, A., Klingberg, S., Wittorf, A., König, H.H.The cost of schizophrenia in Germany: a systematic review of the literature [German]. Psychiatr Prax 2009;36:211–218.CrossRefGoogle Scholar
Koopmanschap, M.A., Rutten, F.F.H., van Ineveld, B.M., van Roijen, L.The friction cost method for measuring indirect costs of disease. J Health Econ 1995;14:171–189.CrossRefGoogle ScholarPubMed
Kreif, N., Grieve, R., Radice, R., Sadique, Z., Ramsahai, R., Sekhon, J.S.Methods for estimating subgroup effects in cost-effectiveness analyses that use observational data. Med Decis Making 2012;32(6):750–763.CrossRefGoogle ScholarPubMed
Kuo, R.N., Dong, Y.H., Liu, J.P., Chang, C.H., Shau, W.Y., Lai, M.S.Predicting healthcare utilization using a pharmacy-based metric with the WHO's anatomic therapeutic chemical algorithm. Med Care 2011;49:1031.CrossRefGoogle ScholarPubMed
Larg, A., Moss, J.R.Cost-of-illness studies. Pharmacoeconomics 2011;29:653–671.CrossRefGoogle ScholarPubMed
Lauber, C., Eichenberger, A., Luginbühl, P., Keller, C., Rössler, W.Determinants of burden in caregivers of patients with exacerbating schizophrenia. Eur Psychiatry 2003;18:285–289.CrossRefGoogle ScholarPubMed
Lewine, R.R.J.Social class of origin, lost potential, and hopelessness in schizophrenia. Schizophr Res 2005;76:329–335.CrossRefGoogle Scholar
Liljas, B.How to calculate indirect costs in economic evaluations. Pharmacoeconomics 1998;13:1–7.CrossRefGoogle ScholarPubMed
Magliano, L., Fiorillo, A., De Rosa, C., Malangone, C., Maj, M.Family burden in long-term diseases: a comparative study in schizophrenia vs. physical disorders. Soc Sci Med 2005;61:313–322.CrossRefGoogle ScholarPubMed
Mangalore, R., Knapp, M.Cost of schizophrenia in England. J Ment Health Policy Econ 2007;10:23–41.Google ScholarPubMed
Mauskopf, J.Prevalence-based economic evaluation. Value Health 1998;1:251–259.CrossRefGoogle ScholarPubMed
McGrath, J., Saha, S., Chant, D., Welham, J.Schizophrenia: a concise overview of incidence, prevalence, and mortality. Epidemiol Rev 2008;30:67–76.CrossRefGoogle Scholar
Mebane, W.R. Jr., Sekhon, J.S.Genetic optimization using derivatives: the rgenoud package for R. J Stat Softw 2011;42:1–26.CrossRefGoogle Scholar
Ohaeri, J.U.The burden of caregiving in families with a mental illness: a review of 2002. Curr Opin Psychiatry 2003;16:457–465.CrossRefGoogle Scholar
Osterheider, M., Franken-Hiep, K., Horn, R.Total costs involved in the treatment of schizophrenia and cost evaluation of prophylactic treatment with the depot neuroleptic drug flupentixoldecanoate [German]. Psychiat Prax 1998;25:38–43.Google Scholar
Roick, C., Heider, D., Bebbington, P.E., Angermeyer, M.C., Azorin, J.-M., Brugha, T.S.et al.Burden on caregivers of people with schizophrenia: comparison between Germany and Britain. Br J Psychiatry 2007;190:333–338.CrossRefGoogle ScholarPubMed
Rosenbaum, P.R.Observational Studies. 2002 Springer; New York.CrossRefGoogle Scholar
Rosenbaum, P.R., Rubin, D.B.The central role of the propensity score in observational studies for causal effects. Biometrika 1983;70:41–55.CrossRefGoogle Scholar
Rosenbaum, P.R., Rubin, D.B.Reducing bias in observational studies using subclassification on the propensity score. J Am Stat Assoc 1984;79:516–524.CrossRefGoogle Scholar
Rosenbaum, P.R., Rubin, D.B.Constructing a control group using multivariate matched sampling methods that incorporate the propensity score. Am Stat 1985;39:33–38.Google Scholar
Rubin, D.B.Estimating causal effects of treatments in randomized and nonrandomized studies. J Educ Psychol 1974;66:688–701.CrossRefGoogle Scholar
Rubin, D.B.The design versus the analysis of observational studies for causal effects: parallels with the design of randomized trials. Stat Med 2007;26:20–36.CrossRefGoogle ScholarPubMed
Runge, C., Grunze, H.Annual costs of bipolar disorders in Germany [German]. Nervenarzt 2004;75:896–903.Google Scholar
Salize, H., Rössler, W.The cost of comprehensive care of people with schizophrenia living in the community. A cost evaluation from a German catchment area. Br J Psychiatry 1996;169:42–48.CrossRefGoogle ScholarPubMed
Salize, H.J., Stamm, K., Schubert, M., Bergmann, F., Härter, M., Berger, M.et al.Cost of care for depressive disorders in primary and specialized care in Germany [German]. Psychiatr Prax 2004;31:147–156.Google Scholar
Salize, H., Schuh, C., Krause, M., Reichenbacher, M., Stamm, K., Längle, G.Are vocational rehabilitation programs likely to reduce long-term cost of care for patients with schizophrenia? [German]. Psychiat Prax 2007;34:246–248.CrossRefGoogle Scholar
Salize, H.J., Rössler, W., Becker, T.Mental health care in Germany. Eur Arch Psychiatry Clin Neurosci 2007;257:92–103.CrossRefGoogle ScholarPubMed
Schleuning, G., Heel, S.Distribution of costs in schizophrenia treatment – Approaches to management and integration [German]. Psychiatr Prax 2004;31:6–8.CrossRefGoogle Scholar
Sekhon, J.S.Multivariate and propensity score matching software with automated balance optimization: the matching package for R. J Stat Softw 2011;42:1–52.CrossRefGoogle Scholar
Sekhon, J.S., Grieve, R.D.A matching method for improving covariate balance in cost-effectiveness analyses. Health Econ 2012;21:695–714.CrossRefGoogle ScholarPubMed
Sekhon, J.S., Mebane, W.R. Jr.Genetic optimization using derivatives. Pol Anal 1998;7:187–210.CrossRefGoogle Scholar
Senn, S.J.Covariate imbalance and random allocation in clinical trials. Stat Med 1989;8:467–475.CrossRefGoogle ScholarPubMed
Shepherd, S., Depp, C.A., Harris, G., Halpain, M., Palinkas, L.A., Jeste, D.V.Perspectives on schizophrenia over the lifespan: a qualitative study. Schizophr Bull 2012;38:295–303.CrossRefGoogle ScholarPubMed
Stamm, K., Reinhard, I., Salize, H.J.Long-term health insurance payments for depression in Germany – a secondary analysis of routine data [German]. Neuropsychiatr 2010;24:99–107.Google Scholar
Tandon, R., Keshavan, M.S., Nasrallah, H.A.Schizophrenia. “Just the facts”: what we know in 2008: part 1: overview. Schizophr Res 2008;100:4–19.Google ScholarPubMed
Tandon, R., Keshavan, M.S., Nasrallah, H.A.Schizophrenia “Just the facts” What we know in 2008: part 2: epidemiology and etiology. Schizophr Res 2008;102:1–18.CrossRefGoogle Scholar
Wittchen, H.-U., Jacobi, F.Size and burden of mental disorders in Europe – a critical review and appraisal of 27 studies. Eur Neuropsychopharmacol 2005;15:357–376.CrossRefGoogle ScholarPubMed
Zeidler, J., Slawik, L., Fleischmann, J., Greiner, W.The costs of schizophrenia and predictors of hospitalisation from the statutory health insurance perspective. Health Econ Rev 2012;2:1–9.CrossRefGoogle ScholarPubMed
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