Cost-effectiveness analysis of current treatment of individuals with acute exacerbation of schizophrenia in Bulgaria

Figures & data

Figure 1. Cohort selection.

Table 1. Type of resources evaluated, recall periods, unit cost and the source of data for the unit costs.

Type of resources used and recall period (in months prior to assessment)		Unit	Unit cost (PPP Euro 2015)	Sources of data for unit cost
Psychiatric-related services
Psychiatric inpatient treatment	12	Days	19.84–34.85	National Centre for Public Health and Analysis [34,35]
Psychiatric emergency care	12	Visits	28.34	Methodology for subsidizing the medical establishments for psychiatric emergency [36]
Day patient treatment	12	Visits	22.11–34.58	National Centre for Public Health and Analysis [34,35]
Daycare center	12	Visits	13.97	Standards for the financing of activities delegated by the state [38]
Community group therapy	12	Visits	19.84	CSSRI-EU [32]
Psychiatrist	3	Visits	10.77	National Health Insurance Fund [33]
Psychologist/Psychotherapist	3	Visits	22.67	CSSRI-EU [32]
Nurse	3	Visits	5.67–10.20	National Health Insurance Fund [33]
Laboratory tests	3	Test	5.50–127.53	National Health Insurance Fund [33]
Psychopharmacotherapy	1	100 mg	0.03–37.85	Positive Drug List [37]
Somatic-related services
Somatic inpatient days	12	Days	61.78–307.78	National Centre for Public Health and Analysis [34,35]
Somatic emergency department	12	Visits	29.47	National Centre for Public Health and Analysis [34,35]
Somatic specialist	3	Visits	10.77–18.36	National Health Insurance Fund [33]
General practitioner	3	Visits	0.60–1.40	National Health Insurance Fund [33]
Somatic pharmacotherapy	1	100 mg	0.13–82.38	Positive Drug List [37]

Table 2. Service use and costs at baseline (T1) and 12-month follow-up (T2).

P	Number (N/%) of participants using services		Mean (SD) amount of services used^a		Mean (SD) monthly cost per patient in PPP Euro 2015
	T1 (n = 57)	T2 (n = 50)	T1	T2	T1 (n = 57)	T2 (n = 50)
Psychiatric services
Inpatient days	23 (40)	50 (100)	43 (36)	28 (20)	37.18 (63.52)	80.94 (52.55)
Emergency visits	5 (9)	0 (0)	1 (0)	0 (0)	0.25 (0.85)	0.00 (0.00)
Day patient visits	4 (7)	7 (14)	28 (6)	24 (9)	5.05 (18.90)	8.71 (23.38)
Day care	1 (2)	1 (2)	60 (0)	60 (0)	5.15 (38.86)	5.87 (41.49)
Community group therapy	0 (0)	1 (2)	0 (0)	30 (0)	0.00 (0.00)	5.95 (42.08)
Psychiatrist	34 (60)	38 (76)	3 (2)	2 (1)	5.67 (8.00)	5.67 (5.33)
Psychotherapist	5 (9)	0 (0)	2 (3)	0 (0)	1.33 (5.55)	0.00 (0.00)
Nurse	10 (18)	20 (40)	4 (2)	3 (1)	1.81 (4.32)	3.92 (5.32)
Laboratory tests	3 (5)	1 (2)			0.66 (2.83)	0.79 (5.61)
Psychopharmacotherapy	42 (74)	45 (90)			38.61 (84.92)	65.42 (110.59)
Somatic services
Somatic inpatient days	11 (19)	3 (6)	11 (13)	7 (6)	24.79 (99.15)	4.55 (21.02)
Emergency visits	4 (7)	2 (4)	1 (1)	1 (0)	0.22 (0.84)	0.10 (0.49)
Somatic specialist	13 (23)	12 (24)	2 (2)	2 (1)	1.81 (5.25)	1.49 (3.93)
General practitioner	32 (56)	20 (40)	2 (1)	2 (1)	0.24 (0.30)	0.12 (0.19)
Pharmacotherapy	19 (33)	15 (30)			12.99 (63.70)	5.54 (14.86)

^aOnly for those in contact with such services.

Table 3. Comparison of costs^a and outcomes at baseline (T1) and 12-month follow-up (T2).

Comparison of costs^a and outcomes	T1		T2		Significance
	N points	Mean (SD)	N points	Mean (SD)
Total costs^a from healthcare perspective	57	135.75 (193.36)	50	189.00 (126.98)	−58.06 (−112.48; −2.31)^b
Subtotal for psychiatric costs^a	57	95.71 (127.31)	50	177.21 (124.32)	−77.83 (−122.81; −30.25)^b
Subtotal for somatic costs^a	57	40.05 (121.77)	50	11.79 (26.38)	32.06 (3.69; 71.01)^b
Outcomes
PANSS	57	88 (15)	50	57 (16)	t(49)=10.837, p < 0.001^c
PSP	57	34 (17)	50	65 (17)	t(49)= −9.704, p < 0.001^c
MANSA	57	51 (12)	38	60 (10)	t(37)=3.704, p < 0,001^c
BAS	57	45 (11)	49	35 (12)	t(48)=5.834, p < 0.001^c

^aMean monthly costs per patient in PPP Euro 2015.

^bMean difference and 95% confidence interval of the bootstrapped test for paired samples.

^ct-test for paired samples.

Table 4. Results of cost-effectiveness analysis.

Outcome measure	Time period	N points	Total Monthly Costs (C) per patient	Outcome (E)	ΔC	ΔE	ICER (ΔC/ΔE)
			Mean (SD)	Mean (SD)	Mean (SD)	Mean (SD)	N	Mean (SD)
PANSS	T1	57	135.75 (193.36)	88 (15)
	T2	50	189.00 (126.98)	57 (16)	58.06 (197.01)	31 (20)	50	3.04 (13.35)
PSP	T1	57	135.75 (193.36)	34 (17)
	T2	50	189.00 (126.98)	65 (17)	58.06 (197.01)	31 (23)	48	4.95 (21.84)
MANSA	T1	57	135.75 (193.36)	51 (12)
	T2	38	201.06 (133.81)	60 (10)	76.37 (188.23)	9 (16)	37	11.21 (104.38)
BAS	T1	57	135.75 (193.36)	45 (11)
	T2	49	184.56 (124.32)	35 (12)	50.95 (192.45)	8 (10)	42	13.22 (33.53)

*N – number of participants; SD – standard deviation; ΔC – differences in the costs; ΔE – differences in the outcomes; ICER – incremental cost-effectiveness ratio; PANSS – the Positive And Negative Syndrome Scale; PSP – the Personal and Social Performance Scale; MANSA – the Manchester Short Assessment of Quality of Life; BAS – the Burden Assessment Scale.

Figure 2. Distribution of bootstrapped incremental cost-effectiveness ratios (ICERs) (n = 1000) in the cost-effectiveness plane for PANSS (A), PSP (B), MANSA (C) and BAS (D).

Figure 3. Cost-effectiveness acceptability curves based on the willingness to pay for 1 unit improvement in PANSS (A), PSP (B), MANSA (C) and BAS (D).

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Data availability statement

The data that support the findings of this study are available from the corresponding author, [MK], upon reasonable request.