Understanding costs associated with providing health-care services can provide insights into health-care needs. A recent study from researchers from the Centre for Addiction and Mental Health (CAMH) and the Institute for Clinical Evaluative Sciences (ICES) shows how the costs of treating psychotic illnesses in Ontario change as individuals with psychotic disorders age.
Chronic psychotic disorders, such as schizophrenia, are severe and disabling, and are associated with poor psychiatric and medical outcomes. These disorders are considered among the most costly mental illnesses due to the young age at onset of illness and the need for intensive health care over an individual's lifetime.
Published in December 2016 in The Journal of Mental Health Policy and Economics, the study found that health-care costs associated with treating psychotic illnesses were just under $2.1 billion in 2012 – about four per cent of the total provincial health budget.
“We already knew that costs for treating psychotic illnesses were high, but what this study shows is how early patients start incurring long-term care costs,” says Dr. Claire de Oliveira, author of the study and Scientist at both CAMH’s Institute for Mental Health Policy Research and ICES. "People with psychotic illnesses as young as 46 are in long-term care facilities, which is very young."
Individuals with chronic psychotic illnesses also have complex medical needs related to their physical health, which accounted for the change in health-care costs with age. In younger people, the majority of health-care costs were associated with psychiatric hospitalizations. As individuals aged, long-term care and medical hospitalizations accounted for a greater share of total health-care costs, suggesting the development of different health-care needs over time.
“These findings highlight the need to address both physical and mental health simultaneously in younger patients to avoid more serious conditions developing, and to manage the comorbidity in older individuals,” adds Dr. de Oliveira.
The study found there were 142,821 patients over the age of 15 with a chronic psychotic illness in Ontario in 2012 – this represents roughly 1.2 per cent of the population over the age of 15. The average age was 49 years. Most individuals lived in low-income, urban neighbourhoods. Roughly 17 per cent had a psychiatric hospitalization in the year studied, with an average of two hospitalizations and an average length of stay of 49 days.
The study also found that younger patients with psychosis had five to nine times higher health-care costs associated with psychiatric hospitalizations in the study period, compared with the health-care costs of young people without psychosis.
The over-65 age group had the highest costs overall. More than half of their health-care costs were associated with long-term care and medical hospitalizations.
“Our results suggest that the needs of patients with chronic psychotic illnesses change over time, and that those needs become more complex as people age. This complexity is reflected in the high and diverse health-care costs in older patients,” says Dr. Paul Kurdyak, co-author of the study and Clinician Scientist with the Institute for Mental Health Policy Research and Medical Director of Performance Improvement at CAMH. He is also Lead of the Mental Health and Addictions Research Program at ICES and Director of Health Outcomes at the Medical Psychiatry Alliance.
Direct health-care costs included in the study were costs associated with hospitalizations, emergency department visits, physician services and diagnostics tests, outpatient prescription drugs for individuals covered under the Ontario Drug Benefit program, home care, long-term care, and other care (including other ambulatory care, such as same-day surgery/procedures, and cancer and dialysis clinics; other hospital-based care, such as rehabilitation and complex continuing care; and assistive devices). The study did not include costs for addiction services.
The research was supported in part by the Medical Psychiatry Alliance (MPA), a collaborative health partnership of CAMH, the Hospital for Sick Children, Trillium Health Partners, the University of Toronto, the Ontario Ministry of Health and Long-Term Care and an anonymous donor. The MPA’s goal is to provide better access to, and coordination of, integrated health-care services for patients living with co-existing mental and physical illnesses.