Economic Evaluation of Mental Health Interventions: A Cost-Consequence Analysis

OBJECTIVES: To determine the cost-consequence by therapeutic scheme of the comprehensive management of schizophrenia, related to clinical and non-clinical outcomes in 5 reference centers in Colombia between 2019 and 2023.

METHODS: First, a disaggregated comparison is made of the costs and clinical and non-clinical outcomes by therapeutic scheme and population group, under three time frames (short, medium and long term) in the established period. Subsequently, each of the variables is analyzed by health outcome and their respective cost to determine which therapy generates the greatest value for the health system.

RESULTS: Relating outcomes such as: response to treatment (improvement of positive, negative or global psychotic symptoms, evaluated with scales), remission of psychotic symptoms, relapses, social functioning, occupational functioning, global state and quality of life of the patient and caregiver; and assuming that the patient actually takes the medication, the extended-release injectable has better health outcomes and presents better social reintegration of the patient after the first year of adherence: Hospitalization rate of 1.89%, 0.26% relapse rate, 93.6% functionality in patients, savings to the health system at one year of 33. 910 USD per patient.

For oral drugs, the effective consumption of the drug by the patient cannot be guaranteed and, together with a relatively lower effectiveness, the clinical and non-clinical results are inferior: hospitalization rate of 41.4%, relapse rate of 49.67% and functionality without statistical significance.

CONCLUSIONS: In patients over 18 years of age with a previous diagnosis of schizophrenia or schizophreniform disorder and requiring acute/chronic episode management, or evidence of a substance-induced psychotic disorder, extended-release injectables are shown to generate savings to the system of 18 million UDS per year for a cohort of 532 patients. Relating indirect costs, social functionality and reduction of patient/caregiver burden, this therapeutic option is highly recommended.