title: The difficult task of predicting the costs of community-based mental health care. A comprehensive case register study.
abstract: BACKGROUND
  Previous studies have attempted to forecast the costs of mental health care, using clinical and individual variables; the inclusion of ecological measures could improve the knowledge of predictors of psychiatric service utilisation and costs to support clinical and strategic decision-making.
  
  
  METHODS
  Using a Psychiatric Case Register (PCR), all patients with an ICD-10 psychiatric diagnosis, who had at least one contact with community-based psychiatric services in the Verona Health District, Northern Italy, were included in the study (N = 4558). For each patient, one year's total cost of care was calculated by merging service contact data with unit cost estimates and clinical and socio-demographic variables were collected. A socio-economic status (SES) index was developed, as a proxy of deprivation, using census data. Multilevel multiple regression models, considering socio-demographic and clinical characteristics of patients as well as socioeconomic local characteristics, were estimated to predict costs.
  
  
  RESULTS
  The mean annual cost for all patients was 2,606.11 Euros; patients with an ongoing episode of care and with psychosis presented higher mean costs. Previous psychiatric history represented the most significant predictor of cost (36.99% R2 increase) and diagnosis was also a significant predictor but explained only 4.96% of cost variance. Psychiatric costs were uniform throughout the Verona Health District and SES characteristics alone contributed towards less than 1% of the cost variance.
  
  
  CONCLUSIONS
  For all patients of community-based psychiatric services, a comprehensive model, including both patients' individual characteristics and socioeconomic local status, was able to predict 43% of variance in costs of care.
authors.affiliation: Section of Psychiatry and Clinical Psychology, Department of Public Health and Community Medicine, University of Verona, Verona, Italy. valeria.donisi@univr.it
authors.forename: V
authors.initials: V
authors.lastname: Donisi
authors.forename: J
authors.initials: J
authors.lastname: Jones
authors.forename: R
authors.initials: R
authors.lastname: Pertile
authors.forename: D
authors.initials: D
authors.lastname: Salazzari
authors.forename: L
authors.initials: L
authors.lastname: Grigoletti
authors.forename: M
authors.initials: M
authors.lastname: Tansella
authors.forename: F
authors.initials: F
authors.lastname: Amaddeo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003156:Community Mental Health Services / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D008297:Male; D001523:Mental Disorders / Q000191:economics* / Q000628:therapy*; D008603:Mental Health; D008875:Middle Aged; D012042:Registries / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D055815:Young Adult