Financial cost of treating Nigerian in-patients with schizophrenia

Abstract

Fifty seven each of hospitalised schizophrenic patients (fulfilled diagnostic criteria for research version of I.C.D. 10) and diabetic patients respectively, matched forage and sex, were followed up from admission to discharge (July 1997 - December 1997). B.P.R.S. w a s used to measure the severity of psychopathology at admission and discharge for the former, while the levels of blood glucose at admission and discharge were assessed for the latter. Also, interviewed during the study were 3 7 4 relatives comprising 102 and 272 relatives of schizophrenic and diabetic patients respectively. Weekly assessments of cost of treatment wer e done from admission to discharge using the proforma which took cognisance of aspects of direct and indirect costs for patients and relatives of both groups. Schizophrenic patients had a poorer employmen t record ( P = 0.000), more diabetic patients were married ( P = 0.000), relatives shouldered the financial burden of care of more schizophrenic patients (P=0.000), more schizophreni c patients travelled over an average of 122 km to reach the hospital whereas diabetic patients travelled averagely 19.8 k m ( P = 0.000) and the mean duration of admission for schizophrenic patients w a s significantly longer (P=0.000). The mea n monthly income for diabetic patients was significantly higher than for schizophrenic patients (P=0.000), and t h e mean direct cost for schizophreni a p e r admission N9,882.0 0 w a s significantly higher than that of diabetes mellitus N7,892.0 0 ( P = 0.000). T h e mean indirect cost for schizophrenic patients per admission which is N3,604.00 did not differ significantly from that of diabetic patients of Nl,488.0 0 ( P = 0.288). T e mean total cost of schizophrenia p e r admission - is N11,337.0 0 and was significantly higher than for diabetes N8,571.0 0 (P = 0.000). However, the mean direct cost per week for diabetes mellitus N4,494.00 wa s significantly higher than for schizophrenia N1,011.00 (P=0.00 T h e mea n indirect cost for diabetes mellitus per week N406.00 did not differ significantly from that of schizophrenia N 168.00 (P = 0.602). T h e mean total cost of diabetes mellitus per week N4,910.0 0 w a s significantly higher than for schizophrenia N1,235.0 0 (P=0.000). Cost of medication ranked highest in all items of cost for both the schizophrenic and diabetic cohorts. The implications of the findings on clinical practice in Nigeria and our current socio- economic scenario (especially with regard to schizophrenic patients and their families) are discussed. The need to reinforce the socio-economic support from government and the larger society for schizophrenic patients and their families is highlighted