title: Evidence for Distinguishable Treatment Costs among Paranoid Schizophrenia and Schizoaffective Disorder.
abstract: BACKGROUND
  Schizophrenia spectrum disorders result in enormous individual suffering and financial burden on patients and on society. In Germany, there are about 1,000,000 individuals suffering from schizophrenia (SZ) or schizoaffective disorder (SAD), a combination of psychotic and affective symptoms. Given the heterogeneous nature of these syndromes, one may assume that there is a difference in treatment costs among patients with paranoid SZ and SAD. However, the current the national system of cost accounting in psychiatry and psychosomatics in Germany assesses all schizophrenia spectrum disorders within one category.
  
  
  METHODS
  The study comprised a retrospective audit of data from 118 patients diagnosed with paranoid SZ (F20.0) and 71 patients with SAD (F25). We used the mean total costs as well as partial cost, i.e., mean costs for medication products, mean personal costs and mean infrastructure costs from each patient for the statistical analysis. We tested for differences in the four variables between SZ and SAD patients using ANCOVA and confirmed the results with bootstrapping.
  
  
  RESULTS
  SAD patients had a longer duration of stay than patients with SZ (p = .02). Mean total costs were significantly higher for SAD patients (p = .023). Further, we found a significant difference in mean personnel costs (p = .02) between patients with SZ and SAD. However, we found no significant differences in mean pharmaceutical costs (p = .12) but a marginal difference of mean infrastructure costs (p = .05) between SZ and SAD. We found neither a common decrease of costs over time nor a differential decrease in SZ and SAD.
  
  
  CONCLUSIONS
  We found evidence for a difference of case related costs of inpatient treatments for paranoid SZ and SAD. The differences in mean total costs seem to be primarily related to the mean personnel costs in patients with paranoid SZ and SAD rather than mean pharmaceutical costs, possibly due to higher personnel effort and infrastructure.
authors.affiliation: Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany.
authors.forename: Dusan
authors.initials: D
authors.lastname: Hirjak
authors.affiliation: Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany.
authors.forename: Achim
authors.initials: A
authors.lastname: Hochlehnert
authors.affiliation: Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany.
authors.forename: Philipp Arthur
authors.initials: PA
authors.lastname: Thomann
authors.affiliation: Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany.
authors.forename: Katharina Maria
authors.initials: KM
authors.lastname: Kubera
authors.affiliation: Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany.
authors.forename: Knut
authors.initials: K
authors.lastname: Schnell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D057286:Electronic Health Records; D005260:Female; D005858:Germany; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000191:economics; D008875:Middle Aged; D011570:Psychiatry / Q000191:economics; D011602:Psychophysiologic Disorders / Q000191:economics; D011618:Psychotic Disorders / Q000191:economics* / Q000628:therapy*; D012189:Retrospective Studies; D012563:Schizophrenia, Paranoid / Q000191:economics* / Q000628:therapy*; D055815:Young Adult