Zusammenfassung
Im Rahmen einer prospektiven Längsschnittstudie mit 5 Messzeitpunkten wurden die direkten Kosten der psychiatrischen Versorgung sowie klinische und soziale Merkmale von 307 Patienten mit schizophrenen Erkrankungen (ICD-10 F 20.0) über einen Zeitraum von 2,5 Jahren erfasst. Zur Längsschnittanalyse der Einflussfaktoren der Kostenvarianz wurde ein Random-Effect-Regressionsmodell berechnet. Eine Differenzierung von Längs- und Querschnitteffekten der unabhängigen Variablen erfolgte mittels Gegenüberstellung eines Within-Effect- und eines Between-Effect-Regressionsmodells. Die Ergebnisse der Studie zeigen, dass 10 % der Within-Varianz und 32 % der Between-Varianz der direkten psychiatrischen Versorgungskosten durch das Random-Effect-Modell erklärt werden. Signifikante Längsschnitteffekte werden für das Eintreten eines psychotischen Rückfalls und für die Veränderung des Funktionsniveaus festgestellt. Querschnitteffekte zeigen sich für die Lebenssituation, die Partnerschaft, die Zahl stationärer Voraufenthalte, die Symptomatik, Depression, Alkoholmissbrauch und die Zahl kritischer Lebensereignisse. Die Ergebnisse zeigen, dass Interventionen zur Kosteneinsparung nicht nur auf der medizinischen, sondern auch auf der psychosozialen Ebene angesiedelt sein müssen. Das Verhältnis der erklärten Within- und Between-Varianzanteile macht gleichzeitig deutlich, dass die Möglichkeiten einer Beeinflussung der Versorgungskosten durch patientenbezogene Interventionen begrenzt sind.
Abstract
In a prospective longitudinal study with 5 points of measurement the direct service costs as well as the clinical and social characteristics of 307 outpatients with the diagnosis of schizophrenia (ICD 10 F 20.0) were assessed over a period of 2.5 years. A random-effect regression model was computed for the assessment of the impact of clinical and social variables on cost variance. Within-effect and between-effect of independent variables on the cost variance were identified by comparing of within and between effect models. Results of the study show that 10 % of the within variance and 32 % of the between variance were explained by the random effect model. Significant within effects were found for a deterioration of emotional health status and for general level of functioning. Significant between effects were found for living situation, partnership, number of inpatient episodes, psychopathological symptoms, depression, alcohol abuse and number of life events. The study results suggest that interventions aiming at the reduction of direct costs should not be restricted to medical treatment but must also include psychosocial interventions for the enhancement of general functioning. However, the explained proportions of within and between variance reveal that the possibilities of manipulating direct treatment costs by means of patient-related interventions may be limited.
Schlüsselwörter
Gesundheitsökonomie - Schizophreniebehandlung - direkte Kosten - Längsschnittanalyse - Random-Effekt-Regression
Key words
Health economy - schizophrenia treatment - direct costs - longitudinal analysis - random-effect regression
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Dr. Reinhold Kilian
Universität Leipzig, Klinik und Poliklinik für Psychiatrie
Johannissallee 20
04317 Leipzig
eMail: kilr@medizin.uni-leipzig.de
