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 schizo phrenia in two areas with widely differing health service systems. Method: The costs of patients with schizophrenia in the 3 years after the f irst service contact were evaluated (i) in an area (A.) with fully develope d mental health community programmes and (ii) in another area (B) without s uch 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 i n 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 durin g the third year. Conclusion: Direct costs were higher in the area that lacked intermediate m ental health services, mainly due to hospitalization. Non-provision of inte rmediate mental health care may lead to inefficiencies in the healthcare sy stem.