Schizophrenia and Bipolar Disorder Burden and Economic Burden Under an Impact Analysis by Therapeutic Scheme

OBJECTIVES: Determine the Burden of Schizophrenia and Bipolar Disorder and the Economic Burden through an Impact Analysis by Therapeutic Scheme.

METHODS: Based on official sources from the Ministry of Health and surveys of patients and caregivers with schizophrenia in the country, QALYs were constructed as an indicator of disease burden, and the economic impact of the disease on patients with schizophrenia was measured in terms of direct and indirect costs and out-of-pocket expenses. The impact was measured in three scenarios: a baseline study, with no treatment and no optimal management by CPG recommendation; a management under oral medication and, finally, the scenario with extended-release injectables. Lifetime impact was measured in terms of social and occupational functioning, quality of life and a comprehensive approach including health resource consumption. The results were validated with clinical and subject matter experts under an extended Delphi.

RESULTS: The counterfactual scenario of the baseline burden in psychosis is 42,352 DALYs, 75% of these corresponding to Years of Life Lost due to Disability. Disability being precisely the largest proportion of the burden, 18% above the average for all physical illnesses including trauma and acute malnutrition. Under a scenario of extended-release injectable antipsychotics, there is a decrease in the total burden, 42% above that of oral medications. In the economic burden study, from a social perspective, the outcomes with the greatest economic impact are functionality and social and clinical reintegration such as readmissions and hospitalizations.

CONCLUSIONS: Schizophrenia is a disease of high social impact, with higher prevalence in vulnerable populations and affects not only patients but also the entire family/social environment. In disease burden it is above COPD and diabetes, with proximity to more prevalent pathologies such as heart failure and cancer. Patient profiling for therapeutic assignment generates positive impacts on the reduction of the total burden.