Determinants of Direct Cost of Schizophrenia: Findings from a Tertiary Hospital in Northern Nigeria

Abstract

Schizophrenia is a complex and costly illness, exacting heavy socioeconomic burdens on affected individuals, families and society. Few studies in the developing world have assessed the financial cost of schizophrenia and even fewer studies seek to evaluate which factors influence cost. This study therefore set out to determinants the direct cost of schizophrenia using findings from a tertiary hospital in Northern Nigeria. The study design was a comparative longitudinal study which comprised 270 patients with schizophrenia with 90 of them receiving acute phase treatment and 165 caregivers. The study instruments included the Mini International Neuropsychiatric Interview Plus (MINI Plus) used to make ICD-10 diagnosis of schizophrenia, a modified cost of illness questionnaire was used to assess cost of treatment, and the Positive and Negative Syndrome Scale used to assess symptoms' severity. The results obtained using the SPSS statistical package, version 20 revealed the mean age of participants to be 33.04 years (SD±9.743), with mean age at onset of schizophrenia to be 25.87 years (±8.139). Most of the participants were found to be single (45.6%) and of low socioeconomic class (88.5%). The Cost of illness had a statistically significant relationship with participants' illness presentation, number of caregivers, length of caregiving, illness severity, and socioeconomic status (SES). Mean monthly estimate of direct cost of treatment per patient was N55,464.75 ($133.67) for acute patients, and N6,743.75 ($16.25) for stable patient at an exchange rate of $1=N415. Conventional antipsychotics were the most prescribed. Regression analysis revealed the predictors of direct cost to be length of caregiving and SES. The conclusions from this study showed the determinants of direct cost of schizophrenia to include illness presentations, SES, length of caregiving, and illness severity with participants suffering frequent relapse or delayed intervention due to financial demands of treatment. Consequently, the intervention of government and policy makers in this regard will not only help in reducing patients' suffering and complications of prolonged non-treatment but also reduced the frequency of relapse and the burden on caregivers, government institutions and society.