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Evaluating costs of mental illness in Italy. The development of a methodology and possible applications

Published online by Cambridge University Press:  11 October 2011

Francesco Amaddeo ,
Paola Bonizzato ,
Franco Rossi ,
Jennifer Beecham ,
Martin Knapp  and
Michele Tansella
Francesco Amaddeo*
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona, Verona, Italy
Paola Bonizzato
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona, Verona, Italy
Franco Rossi
Affiliation:
Istituto di Economia Sanitaria, Milano, Italy
Jennifer Beecham
Affiliation:
Centre for the Economics of Mental Health, Institute of Psychiatry, University of London, London, UK
Martin Knapp
Affiliation:
Centre for the Economics of Mental Health, Institute of Psychiatry, University of London, London, UK
Michele Tansella
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona, Verona, Italy
*
Indirizzo per la corrispondenza: Dr. F. Amaddeo, Servizio di Psicologia Medica, Istituto di Psichiatria, Ospedale Policlinico, 37134 Verona. Fax: (+39)045 - 585.871. E-mail: netfra@borgoroma.univr.it
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Summary

Objective - After a review of recent developments in the economic evaluation of mental health care, the study described in this paper suggests a methodology for the measurement and evaluation of costs in the Italian psychiatric system. Method and results - To conduct such an evaluation it is necessary to identify all relevant services, collect data on patients' receipt or utilization of health services (direct costs) and other services and resources within the socio- economic system (indirect costs), and to attach monetary values for the costs. A detailed unit cost list (LICU) was constructed for facilities available at South-Verona Community Psychiatric Service (CPS), as well as in many other community-based psychiatric services in Italy. This list covers psychiatric services, other public and private health services, criminal justice services, voluntary organisations and self-help groups. The procedure for calculating costs in three of these facilities (hospital inpatient service, psychiatric outpatient service and rehabilitation groups) are described in this paper in detail. A new instrument (ICAP) was developed to collect the data required to calculate the costs of community care for individual patients. In order to check the applicability and comprehensibility of the instrument, and the time ne- eded for its administration, the ICAP was tested with five patients. Conclusions - It will be interesting to utilise ICAP and LICU in a larger sample. The methodology described here would provide the basis for epidemiologically-based studies, as well as exploration of the factors which predict cost differences (such as socio-demographic characteristics, diagnosis, psychiatric history, ecc). It is important to emphasise the insights for policy and practice which can flow for the merged examination of costs, needs and outcomes. This research is presently in progress in South-Verona.

Riassunto

Scopo - Il presente lavoro, oltre a fare il punto sui più recenti sviluppi della valutazione economica degli interventi effettuati nel settore della salute mentale, propone una metodologia per la valutazione dei costi, applicable nella situazione assistenziale italiana, messa a punto tenendo conto degli sviluppi suddetti. Metodo e risultati - I presupposti per realizzare questo tipo di valutazione sono l'identificazione dei servizi sanitari e sociali offerti ai pazienti con disturbi psichici, la raccolta di dati sull'utilizzazione dei servizi sanitari (costi diretti) e sull'uso di altri servizi e risorse all'interno del sistema socio-economico (costi indiretti) e l'assegnazione di un valore monetario a tali costi. È stato quindi realizzato un elenco dettagliato degli interventi effettuati e delle attività svolte nei Servizi Psichiatrici Territoriali italiani, con particolare riferimento al Servizio di Verona-Sud. Di ciascuno/a di essi è stato stimato il costo (Lista dei Costi Unitari o LICU). Si è tenuto conto, inoltre, degli altri servizi socio-sanitari, pubblici e privati, disponibili sul territorio, degli interventi delle Forze dell'ordine, delle associazioni di volontariato e dei gruppi di self-help. In questo articolo vengono descritte, in dettaglio, le procedure che hanno portato alia quantificazione dei costi per tre di queste attività (le degenze in SPDC, le visite ambulatoriali ed i gruppi socio-riabilitativi). È stata inoltre sviluppata un'intervista (ICAP) per raccogliere i dati sull'utilizzazione dei servizi e sulle condizioni socio-economiche degli utenti. Per verificarne l'applicabilità, le eventuali difficoltà di comprensione e la durata di somministrazione, l'ICAP è stata testata in cinque pazienti. Conclusioni - Uno sviluppo particolarmente interessante ci sembra quello di utilizzare su vasta scala PICAP e la LICU, allo scopo di realizzare studi epidemiologically-based e poter predire ed analizzare i costi in relazione a variabili socio-demografiche, alia diagnosi, alia storia psichiatrica precedente ecc. È necessario sottolineare l'importanza, per le politiche e la pratica sanitaria, di un'analisi combinata di costi, bisogni ed esito (outcome). Una ricerca di questo tipo è attualmente in corso a Verona-Sud.

Keywords

analisi dei costiservizi psichiatricicosti delle malattieoutcomecosts evaluationmental health servicescost of illnessoutcome
Type
Articles
Information
Epidemiology and Psychiatric Sciences , Volume 4 , Issue 2 , August 1995 , pp. 145 - 162
Copyright
Copyright © Cambridge University Press 1995

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