Healthcare expenditures among individuals with chronic psychotic disorders in Ontario: an analysis over time

Chronic psychotic disorders are severe and disabling mental disorders associated with poor psychiatric and medical outcomes, and among the most costly mental disorders to treat. Understanding trends in aggregate healthcare expenditures over time, and respective drivers, can provide relevant insights for decision makers, namely around appropriate allocation of scarce resources within the healthcare sector. Using administrative healthcare times series data from Ontario, this analysis examined trends in aggregate public healthcare expenditures and activity from 2012 to 2019 among all individuals with a diagnosis of a chronic psychotic disorder. Total aggregate healthcare expenditures for individuals with a chronic psychotic disorder in Ontario increased at a moderate rate over this time period, in line with the growth of the number of people diagnosed, and thus not likely driven by unit costs or resource use. Psychiatric hospitalisations made up the largest share of healthcare expenditures (~30%). Nonetheless, among all health services, expenditures of acute medical hospitalisations, outpatient prescription drugs and home care saw the largest growth over time. Mean/per capita healthcare expenditures were greater for females, and increased with age as well as with the presence of comorbidities/chronic conditions. In particular, mean/per capita healthcare expenditures increased steadily with the number of comorbidities and were highest for individuals with 5 or more comorbidities and those with congestive heart failure, highlighting the ever-increasing importance of addressing physical health conditions among this patient population. These findings will have important implications for decision makers, namely around the appropriate allocation of healthcare resources for patients with chronic psychotic disorders. Future research should continue to monitor healthcare expenditures for individuals with chronic psychotic disorders as well as extend this analysis beyond 2019 to understand how the COVID-19 pandemic, and resulting lockdowns, has impacted aggregate healthcare expenditures and outcomes for patients living with chronic psychotic disorders.