Information about unit costs of psychiatric care is largely unavailable in Central and Eastern Europe, which poses an obstacle to economic evaluations as well as evidence-based development of the care in the region.
The objective of this study was to calculate the unit costs of inpatient and community mental health services in Czechia and to assess the current practices of data collection by mental healthcare providers.
We used bottom-up microcosting to calculate unit costs from detailed longitudinal accounts and records kept by three psychiatric hospitals and three community mental health providers.
An inpatient day in a psychiatric hospital costs 1504 Czech koruna (CZK; €59), out of which 75% is consumed by hotel services and the rest by medication and therapies. The costed inpatient therapies include individual therapies provided by a psychiatrist or psychologist, consultations with a social worker, group therapies, organised cultural activities and training activities. As regards the community setting, we costed daycare social facilities, case management services, sheltered housing, supported housing, crisis help, social therapeutic workshops, individual placement and support, and self-help groups.
The unit costs enable assigning financial value to individual items monitored by the Czech version of the Client Service Receipt Inventory, and thus estimation of costs associated with treatment of mental health problems. The employed methodology might serve as a guideline for the providers to improve data collection and to calculate costs of services themselves, with this information likely becoming more crucial for payers in the future.
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The hospitals record their overhead costs differently. PH1 is most accurate, assigning them to several cost centres performing services shared by the entire hospital, such as management or security. The other two hospitals instead report tens (PH2) to hundreds (PH3) of entries defined by what the money was spent on, e.g. food for employees; we logically sorted these entries, relying on categories based on PH1’s classification and adding four more: General material, Medical material, Rents, fees, taxes and Depreciation. The different accounting practices significantly limit usefulness of any direct comparison. To illustrate, while PH1 assigns depreciation of assets to the cost centre that uses these assets (e.g. management, security or particular ward), PH2 and PH3 report overall depreciation as a separate entry without distinguishing between the functions for which the assets are used. Table 2 should thus be understood as only an illustration of items that are considered overhead costs.
Inpatient day without any depreciation × 100/(100 – mean depreciation share).
[Inpatient day PH Petrohrad Ward1 + Inpatient day PH Opava Ward1 + (Inpatient day PH Bohnice Ward1 + Inpatient day PH Bohnice Ward2 + Inpatient day PH Bohnice Ward3 + Inpatient day PH Bohnice Ward4)/4]/3.
Inpatient week = inpatient day × 7.
Ministry of Health of the Czech Republic. Psychiatric care reform strategy. Prague: MHCR; 2013.
Beecham J, Knapp M. Costing psychiatric interventions. In: Thornicroft G, editor. Measuring mental health needs. London: Gaskell; 2001. p. 544.
Graves N, Walker D, Raine R, Hutchings A, Roberts JA. Cost data for individual patients included in clinical studies: no amount of statistical analysis can compensate for inadequate costing methods. Health Econ. 2002;11(8):735–9.
Knapp M. Principles of applied cost research. In: Netten A, Beecham J, editors. Costing community care: theory and practice. Cambridge: Cambridge University Press; 1993.
Winkler P, Koeser L, Kondrátová L, Broulíková HM, Páv M, Kališová L, et al. Cost-effectiveness of care for people with psychosis in the community and psychiatric hospitals in the Czech Republic: an economic analysis. Lancet Psychiatry. 2018;5(12):1023–31.
Kalisova L, Pav M, Winkler P, Michalec J, Killaspy H. Quality of care in long-term care departments in mental health facilities across the Czech Republic. Eur J Public Health. 2018;28(5):885–90.
Beecham J, Knapp M. Costing psychiatric interventions. In: Thornicroft G, editor. Measuring mental health needs. 2nd ed. London: Gaskell; 2001. p. 163–83.
Chisholm D, Knapp MRJ, Knudsen HC, Amaddeo F, Gaite L, van Wijngaarden B. Client Socio-Demographic and Service Receipt Inventory—European Version: development of an instrument for international research: EPSILON study 5. Br J Psychiatry. 2000;177(S39):s28–33.
Winkler P, Barrett B, McCrone P, Csémy L, Janous̆ková M, Höschl C. Deinstitutionalised patients, homelessness and imprisonment: systematic review. Br J Psychiatry. 2016;208(5):421–8.
Kunitoh N. From hospital to the community: the influence of deinstitutionalization on discharged long-stay psychiatric patients. Psychiatry Clin Neurosci. 2013;67(6):384–96.
Winkler P, Mladá K, Krupchanka D, Agius M, Ray MK, Höschl C. Long-term hospitalizations for schizophrenia in the Czech Republic 1998–2012. Schizophr Res. 2016;175(1):180–5.
Winkler P, Krupchanka D, Roberts T, Kondratova L, Machů V, Höschl C, et al. A blind spot on the global mental health map: a scoping review of 25 years’ development of mental health care for people with severe mental illnesses in central and eastern Europe. Lancet Psychiatry. 2017;4(8):634–42.
Raftery J. Economics notes: costing in economic evaluation. BMJ. 2000;320(7249):1597.
Bebbington A. Calculating unit costs of centre for people with AIDS/HIV. In: Netten A, Beecham J, editors. Costing community care: theory and practice. Cambridge: Cambridge University Press; 1993.
Allen C, Beecham J. Costing services: ideals and reality. In: Netten A, Beecham J, editors. Costing community care: theory and practice. Cambridge: Cambridge University Press; 1993.
Tan SS, Rutten F, Van Ineveld B, Redekop W, Hakkaart-van Roijen L. Comparing methodologies for the cost estimation of hospital services. Eur J Health Econ. 2009;10(1):39–45.
Institute of Health Information and Statistics. Economic information on health care 2013. Prague: IHIS; 2014.
Beecham J, Hallam A, Knapp M, Carpenter J, Cambridge P, Forrester-Jones R, et al. Twelve years on: service use and costs for people with mental health problems who left psychiatric hospital. J Mental Health. 2004;13(4):363–77.
Knapp M, Beecham J, McDaid D, Matosevic T, Smith M. The economic consequences of deinstitutionalisation of mental health services: lessons from a systematic review of European experience. Health Soc Care Commun. 2011;19(2):113–25.
Tansella M, Amaddeo F, Burti L, Lasalvia A, Ruggeri M. Evaluating a community-based mental health service focusing on severe mental illness. The Verona experience. Acta Psychiatr Scand. 2006;113(s429):90–4.
Heider D, Bernert S, König H-H, Matschinger H, Hogh T, Brugha TS, et al. Direct medical mental health care costs of schizophrenia in France, Germany and the United Kingdom—findings from the European Schizophrenia Cohort (EuroSC). Eur Psychiatry. 2009;24(4):216–24.
Knapp M, Chisholm D, Leese M, Amaddeo F, Tansella M, Schene A, et al. Comparing patterns and costs of schizophrenia care in five European countries: the EPSILON study. Acta Psychiatr Scand. 2002;105(1):42–54.
Urdahl H, Knapp M, Edgell E, Ghandi G, Haro J, SOHO Study Group. Unit costs in international economic evaluations: resource costing of the Schizophrenia Outpatient Health Outcomes study. Acta Psychiatr Scand. 2003;107:41–7.
The authors are grateful to all participating providers: the psychiatric hospitals Bohnice, Petrohrad and Opava as well as to the community centres Fokus Mladá Boleslav, Fokus Praha and Fokus Opava. Special thanks go to our colleague Markéta Bejdová for her research on community centres.
The authors were supported by the project “Sustainability for the National Institute of Mental Health” (Grant LO1611), with financial support from the Ministry of Education, Youth and Sports of the Czech Republic, and the project “MERRPS” (grant CZ.033.X/0.0/0.0/15_124/0006067), with financial support from the Ministry of Social Affairs of the Czech Republic.
Conflict of interest
Hana M. Broulíková, Petr Winkler, Marek Páv and Lucie Kondrátová state that they have no conflicts of interest to disclose.
This paper has not been presented at any conference or professional meeting. Some of the data (unit costs) have already been used for economic evaluation in the following studies: Winkler P, Koeser L, Kondrátová L, Broulíková HM, Páv M, Kališová L, et al. Cost-effectiveness of care for people with psychosis in the community and psychiatric hospitals in the Czech Republic: an economic analysis. Lancet Psychiatry. 2018;5(12):1023–31; and Winkler P, Broulíková HM, Kondrátová L, Knapp M, Arteel P, Boyer P, et al. Value of schizophrenia treatment II: decision modelling for developing early detection and early intervention services in the Czech Republic. Eur Psychiatry. 2018;53:116–22. These articles address particular mental health interventions and contain only short technical descriptions of unit costs calculation for a small number of selected services in their Appendices.
Data availability statement
The data that support the findings of this study are not publicly available as the dataset contains confidential information. The dataset is available only upon authorisation of the mental healthcare providers cooperating on the study (listed in the Acknowledgements). Further information on the data is available upon request.
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Broulíková, H.M., Winkler, P., Páv, M. et al. Costs of Mental Health Services in Czechia: Facilitating an Evidence-Based Reform of Psychiatric Care. Appl Health Econ Health Policy 18, 287–298 (2020). https://doi.org/10.1007/s40258-019-00501-7