Economic burden in patients with first episode psychosis and difficult to treat schizophrenia related disorders : a study in an Indian setting

Introduction: Patients suffering from psychotic disorders in Low - and Middle - Income Countries (LMICs) face tremendous challenges in meeting their health care needs. The economic costs associated with these disorders put a huge burden on families which results in financial distress. However , compared to diseases such as t uberculosis, there is limited evidence on extent, timing and drivers of such costs, and level of catastrophic health expenditure (CHE) that results. Methods : The NIHR Warwick - India - Canada Psychosis Global Research Group ( WIC - Warwick India Canada ) conduct ed research in two separate but linked patient groups – First Episode Psychosis (FEP) and “difficult - to treat” schizophrenia (dSZ). A cost questionnaire specifically for mental health was developed in this study and WIC (Warwick India Canada) study participants were interviewed at 1 - month and 6 - months post recruitment. Research Questions : What costs are incurred by patients with psychosis and their households in India? What package of care is involv ed in i) diagnosis and treatment of FEP and ii) management of those with difficult to treat schizophrenia, and what are the resources required to deliver this package of care? Results : Mean total costs in month one in OPD were INR 7991 ($107.5) for FE P . I ndirect costs were 78.3% of this total. The direct cost incurred during treatment for dSZ in OPD amounted to INR 3526.36 ($47.4 ) . M ean indirect cost per month was INR 7649.2 or ( $ 103 ) which was 68.4% of total cost and productivity losses were 40.6% of the indirect cost . M ean total cost of dSZ pe r admission was INR 57800.83 ($780.3) in which mean direct expense s incurred w ere INR 14791.6 ($200.0) i.e. 25.6% and mean indirect costs were INR 43009.5 ($578.3) i.e. 74.5% of total. Impact : The findings will be helpful in establishing health and financing strategies by estimating the economic burden of patients with FEP and dSZ and protect ing financially vulnerable households with members requiring mental health care. Moreover, in the absence of health insurance for treatment of mental disorders and other welfare benefits, this study is of immense importance to measure cost barriers in accessing mental health care for patients and inform current mental health care strategies to increase service us age .

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