It is well known that early start of drug use can lead users to psychosocial problems in adulthood, but its relationship with users' direct healthcare costs has not been well established.
To estimate ...the direct healthcare costs of drug dependency treated at a community mental health service, and to ascertain whether early start of drug use and current drug use pattern may exert influences on these costs.
Retrospective cross-sectional study conducted at a community mental health service in a municipality in the state of São Paulo, Brazil.
The relationships between direct healthcare costs from the perspective of the public healthcare system, age at start of drug use and drug use pattern were investigated in a sample of 105 individuals. A gamma-distribution generalized linear model was used to identify the cost drivers of direct costs.
The mean monthly direct healthcare costs per capita for early-start drug users in 2020 were 1,181.31 Brazilian reais (BRL) (274.72 United State dollars (USD) according to purchasing power parity (PPP)) and 1,355.78 BRL (315.29 USD PPP) for late-start users. Early start of drug use predicted greater severity of cannabis use and use of multiple drugs. The highest direct costs were due to drug dependence combined with alcohol abuse, and due to late start of drug use.
Preventive measures should be prioritized in public policies, in terms of strengthening protective factors before an early start of drug use.
Psychosocial care centers for alcohol and drug users (CAPS-ad) are reference services for treatment of drug users within the Brazilian National Health System. Knowledge of their total costs within ...the evidence-based decision-making process for public-resource allocation is essential. The aims here were to estimate the total costs of a CAPS-ad and the costs of packages of care (according to intensity of care); to ascertain the ratio between total CAPS-ad costs and the federal funding allocated; and to describe the methods for estimating unit costs for each CAPS-ad cost component.
Retrospective study conducted in a public community mental health service.
This was a retrospective cost description study on a CAPS-ad located in a city in the state of São Paulo, using a public healthcare provider perspective and a top-down approach, conducted over a 180-day period from March 1 to August 30, 2015.
The total mean monthly costs of the CAPS-ad were BRL 64,017.54. Healthcare staff accounted for 56.5% of total costs. The mean costs per capita and per month for intensive and non-intensive care packages were, respectively, BRL 668.34 and BRL 37.12.
The federal budget allocation covered 62.1% of the CAPS-ad costs and the remaining 37.9% end up funded by the municipal government. The cost of the intensive package of care was 18 times greater than the non-intensive package. Developing criteria for using services and different packages of care based on patients' needs, and optimizing human resources according to specific actions, may improve people's mental health and avoid wasted resources.
Simon et al.
conducted a 52-week prospective cost-utility analysis (CUA) of 201 people with bipolar depression to assess the add-on lamotrigine effectiveness and efficacy (CEQUEL study
) in ...combination with quetiapine. To that end, they compared health gain using the EuroQol 5D- 3L (EQ-5D) between a quetiapine-only and quetiapine plus lamotrigine regimen in a multi-centre randomized control CEQUEL
trial conducted in the United Kingdom and Austria with a health and social care perspective. In the CEQUEL trial, the efficacy of the add-on lamotrigine in decreasing depressive symptoms in Quick Inventory of Depressive Symptomatology (QIDS RS16) was not statistically significant between groups at 12 weeks, although clinical improvement was observed in both. Although this study was designed to assess the add-on lamotrigine efficacy of over 12 weeks, they found a statistical significant effect of the add-on lamotrigine effect in QIDS RS16 at week 52. This article is protected by copyright. All rights reserved.
Community-based mental health services in Brazil Razzouk, Denise; Cheli Caparroce, Daniela; Sousa, Aglae
Consortium psychiatricum (English ed. Online),
2020-Sep-02, Volume:
1, Issue:
1
Journal Article
Peer reviewed
Open access
The shift from the hospital-based model of care to community-based mental health services began three decades ago and is still an ongoing process in Brazil.
To update data on the development of the ...community mental health services network in Brazil in relation to service availability and structure, manpower, pattern of service use, financing, epidemiological studies and the burden of mental disorders, research and national mental health policy.
Searches were constructed to collect data on indexed databases (Medline, Scielo), as well as governmental,NGOs and medical council sources, reports and the grey literature up until 30th March, 2019.
Community mental health services are unevenly distributed in the country. Brazil leads the world in terms of the prevalence of anxiety disorders, ranking fifth for depression prevalence. Violence and suicide rates are two growing factors which exacerbate the prevalence of mental disorders prevalence. An increased reduction of the number of psychiatric beds in the country, in addition to the unbalanced growth of services in the community, has resulted in treatment gaps and the underutilization of services and barriers to treating people with the most severe psychosis. Investment in mental healthcare is still scarce. However, mental health funding is not addressed according to the population´s needs and scientific evidence, resulting in a waste of resources and inefficiency. Programmes and service interruptions are common according to each government mandate.
Successive changes in ideological perspectives have led to the introduction of policies which have caused fragmentation in the mental health system and services. A lack of evaluation and transparency of services and costs are the main barriers to integrating multiple services and planning long-term developmental phases.
In the third in a series of six articles on packages of care for mental disorders in low- and middle-income countries, Jair Mari and colleagues discuss the treatment of schizophrenia.
Guidelines for the treatment of psychoses recommend antipsychotic monotherapy. However, the rate of antipsychotic polytherapy has increased over the last decade, reaching up to 60% in some settings. ...Studies evaluating the costs and impact of antipsychotic polytherapy in the health system are scarce.
To estimate the costs of antipsychotic polytherapy and its impact on public health costs in a sample of subjects with psychotic disorders living in residential facilities in the city of Sao Paulo, Brazil.
A cross-sectional study that used a bottom-up approach for collecting costs data in a public health provider's perspective. Subjects with psychosis living in 20 fully-staffed residential facilities in the city of Sao Paulo were assessed for clinical and psychosocial profile, severity of symptoms, quality of life, use of health services and pharmacological treatment. The impact of polytherapy on total direct costs was evaluated.
147 subjects were included, 134 used antipsychotics regularly and 38% were in use of antipsychotic polytherapy. There were no significant differences in clinical and psychosocial characteristics between polytherapy and monotherapy groups. Four variables explained 30% of direct costs: the number of antipsychotics, location of the residential facility, time living in the facility and use of olanzapine. The costs of antipsychotics corresponded to 94.4% of the total psychotropic costs and to 49.5% of all health services use when excluding accommodation costs. Olanzapine costs corresponded to 51% of all psychotropic costs.
Antipsychotic polytherapy is a huge economic burden to public health service, despite the lack of evidence supporting this practice. Great variations on antipsychotic costs explicit the need of establishing protocols for rational antipsychotic prescriptions and consequently optimising resource allocation. Cost-effectiveness studies are necessary to estimate the best value for money among antipsychotics, especially in low and middle income countries.
Background
Health costs are the main hindrances for expanding community mental health services. Exploring patient profiles and cost predictors may be useful for optimising financial resources. ...However, the deinstitutionalisation process may burden health budgets in terms of supporting multiple community services based on varying levels of need.
Objective
This study assessed accommodation and health service costs, quality of life and clinical and psychosocial profiles among individuals receiving mental healthcare through residential services. Specific accommodation cost predictors were also verified.
Methods
Health costs were assessed from the perspective of a public health provider using a microcosting bottom-up approach at 20 residential services in São Paulo, Brazil. Instruments used to assess health costs and patient profiles included the Brazilian version of the Client Socio-demographic and Service Receipt Inventory (CSSRI), the Mini International Neuropsychiatric Interview (MINI), the Clinical Global Impression–Severity Scale (CGI-S), the Independent Living Skills Survey (ILLS), the Social Behaviour Scale (SBS) and the Quality of Life Scale (QLS).
Results
One hundred and forty-seven residents, predominantly experiencing psychotic disorders, were interviewed. The geographical region and length of time spent living in residential services or in a psychiatric hospital predicted 66% of the variance in accommodation costs. The CGI-S and ILLS scores and years of education explained 52.7% of the variance in quality of life.
Conclusion
Accommodation costs were not driven by patient profile variables, while region and time spent in a hospital or in residential services were the main cost predictors. Semi-staffed homes may be an alternative for resource optimisation among individuals with mild impairment, particularly if strategies for psychosocial rehabilitation and improving quality of life are implemented.
It is well known that early start of drug use can lead users to psychosocial problems in adulthood, but its relationship with users' direct healthcare costs has not been well established.
To estimate ...the direct healthcare costs of drug dependency treated at a community mental health service, and to ascertain whether early start of drug use and current drug use pattern may exert influences on these costs.
Retrospective cross-sectional study conducted at a community mental health service in a municipality in the state of São Paulo, Brazil.
The relationships between direct healthcare costs from the perspective of the public healthcare system, age at start of drug use and drug use pattern were investigated in a sample of 105 individuals. A gamma-distribution generalized linear model was used to identify the cost drivers of direct costs.
The mean monthly direct healthcare costs per capita for early-start drug users in 2020 were 1,181.31 Brazilian reais (BRL) (274.72 United State dollars (USD) according to purchasing power parity (PPP)) and 1,355.78 BRL (315.29 USD PPP) for late-start users. Early start of drug use predicted greater severity of cannabis use and use of multiple drugs. The highest direct costs were due to drug dependence combined with alcohol abuse, and due to late start of drug use.
Preventive measures should be prioritized in public policies, in terms of strengthening protective factors before an early start of drug use.
The aim of this paper is to assess the mental health system in Brazil in relation to the human resources and the services available to the population.
The World Health Organization Assessment ...Instrument for Mental Health Systems (WHO AIMS) was recently applied in Brazil. This paper will analyse data on the following sections of the WHO-AIMS: a) mental health services; and b) human resources. In addition, two more national datasets will be used to complete the information provided by the WHO questionnaire: a) the Executive Bureau of the Department of Health (Datasus); and b) the National Register of Health Institutions (CNS).
There are 6003 psychiatrists, 18,763 psychologists, 1985 social workers, 3119 nurses and 3589 occupational therapists working for the Unified Health System (SUS). At primary care level, there are 104,789 doctors, 184, 437 nurses and nurse technicians and 210,887 health agents.The number of psychiatrists is roughly 5 per 100,000 inhabitants in the Southeast region, and the Northeast region has less than 1 psychiatrist per 100,000 inhabitants. The number of psychiatric nurses is insufficient in all geographical areas, and psychologists outnumber other mental health professionals in all regions of the country. The rate of beds in psychiatric hospitals in the country is 27.17 beds per 100,000 inhabitants. The rate of patients in psychiatric hospitals is 119 per 100,000 inhabitants. The average length of stay in mental hospitals is 65.29 days. In June 2006, there were 848 Community Psychosocial Centers (CAPS) registered in Brazil, a ratio of 0.9 CAPS per 200,000 inhabitants, unequally distributed in the different geographical areas: the Northeast and the North regions having lower figures than the South and Southeast regions.
The country has opted for innovative services and programs, such as the expansion of Psychosocial Community Centers and the Return Home program to deinstitutionalize long-stay patients. However, services are unequally distributed across the regions of the country, and the growth of the elderly population, combined with an existing treatment gap is increasing the burden on mental health care. This gap may get even wider if funding does not increase and mental health services are not expanded in the country. There is not yet a good degree of integration between primary care and the mental health teams working at CAPS level, and it is necessary to train professionals to act as mental health planners and as managers. Research on service organization, policy and mental health systems evaluation are strongly recommended in the country. There are no firm data to show the impact of such policies in terms of community service cost-effectiveness and no tangible indicators to assess the results of these policies.
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