The economic burden of chronic psychotic disorders in Ontario

Background — Chronic psychotic disorders are severe and disabling mental disorders associated with poor psychiatric and medical outcomes. These disorders are considered one of the most costly mental disorders due young age at onset and the need for intensive healthcare over the life course.

Aims of the Study — The purpose of this study was to estimate the direct healthcare costs of chronic psychotic disorders in Ontario in 2012 from the perspective of the third-party payer (i.e., the ministry of health), using a prevalence-based cost-of-illness approach.

Methods — We selected all patients eligible for public health insurance over the age of 15 with a diagnosis of chronic psychotic disorder, using a validated algorithm. Using linked administrative healthcare databases, we estimated net costs associated with chronic psychotic disorders (i.e., the difference in cost for patients with psychosis and control subjects), using a case-control design. Mean net prevalence costs were estimated for the full sample and disaggregated by sex, age group (16-24; 25-44; 45-64; 65 and over) and health service.

Results — In 2012, there were 142,821 patients with a chronic psychotic disorder in Ontario. They had a mean age of 49, were made up of slightly more males (53%) and were mostly from low-income, urban neighbourhoods. Roughly 17% of patients had a psychiatric hospitalization, with an average of 2 hospitalizations and average length of stay of 49 days. The total direct cost of patients with chronic psychotic disorders to the ministry of health was just under $2.1 billion CAD. Total net costs were around $1.5 billion CAD. The main cost drivers were psychiatric hospitalizations (48%), followed by long-term care (14%). Mean net costs were slightly higher for females than males ($10,653 vs. $10,647, respectively). Mean net costs were highest for patients 65 and over, and lowest for patients 25-44 ($15,230 vs. $8,585, respectively). The main cost drivers also varied with age. For younger patients, three-quarters of the net cost were due to psychiatric hospitalizations (74%), while for older patients net costs were mainly due long-term care (38%), followed by psychiatric (24%) and non-psychiatric (14%) hospitalizations.

Discussion and Limitations — The direct net costs of treating patients with chronic psychotic disorders are substantial and represent a sizeable portion of the Ontario healthcare budget (3%). Previous research has found similar findings in other jurisdictions. These estimates do not account for costs of addiction services.

Implications for Healthcare Provision and Use — Our results suggest there are important utilization/cost differences between age groups. As patients with chronic psychotic disorders become older chronic disease and disability become more prominent, as reflected in higher costs with long-term care and non-psychiatric hospitalizations.

Implications for Health Policies — These findings highlight the need for healthcare systems to address both physical and mental illness simultaneously, especially for older patients with chronic psychotic disorders.

Implications for Further Research — Future research should focus on the predictors of care over the life course of patients with chronic psychotic disorders. In addition, further work should examine how the interplay between mental and physical health contribute to increased costs among patients with psychosis.