Service utilization and costs of first-onset schizophrenia in two widely differing health service areas in North-East Spain

Objective: The aim of the study was to analyse the cost-incidence of schizophrenia in two areas with widely differing health service systems. Method: The costs of patients with schizophrenia in the 3 years after the first service contact were evaluated (i) in an area (A) with fully developed mental health community programmes and (ii) in another area (B) without such programmes. The assessment included a standard description of services, as well as clinical, social and disability aspects. Results: Sociodemographic and clinical characteristics were comparable. The mean direct costs for both areas in the 3-year period were, respectively, $4287 and $6540 in year 1, $2416 and $2888 in year 2, and $2120 and $1862 in year 3. Direct costs in area A were 35% lower than those in area B during the first year, 16.4% lower during the second year, and 12.2% higher during the third year. Conclusion: Direct costs were higher in the area that lacked intermediate mental health services, mainly due to hospitalization. Non-provision of intermediate mental health care may lead to inefficiencies in the healthcare system.