Chaiyakunapruk, N.

Chiou, C.F.

Chong, H.Y.

D.B.C., Wu

K.K.C., Lee

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PMH10 Global Economic Burden of Schizophrenia: A Systematic Review 

 VA L U E  I N  H E A LT H  1 7  ( 2 0 1 4 )  A 7 1 9 – A 8 1 3  A767
49-89% of the total annual costs associated with schizophrenia. ConClusions: 
Schizophrenia imposes a substantial economic burden on society mainly driven by 
high indirect costs. The cost estimates varied due to methodology differences and 
costs included. The information of disease burden associated with schizophrenia 
is crucial to enable informed decision-making in allocating health care resources.
PMH11
Burden of Illness of deMentIa In CHIna
Yan J.1, Clay E.2, Liu C.3, Yu S.4, Aballea S.2, Toumi M.5
1Creativ-Ceutical, London, UK, 2Creativ-Ceutical, Paris, France, 3Tongren Hospital Beijing, 
Beijing, China, 4Chinese Center for Disease Control and Prevention, Beijing, China, 5University of 
Marseille, Marseille, France
objeCtives: Due to the rapidly aging population, dementia is becoming a great 
concern in China. Moreover, dementia is associated with an important economic 
burden. The objective of this study was to provide an estimation of the economic 
burden of dementia in China with and without an adequate treatment. Methods: 
A Markov model was developed to simulate transition between a mutually exclusive 
set of health states associated with dementia. Average annual economic burden 
was estimated between patients treated from moderate to severe and patients not 
treated, over a five-year time horizon. The resource categories taken into account 
in the model were treatment, hospitalisations, nursing-home care, biological analy-
ses, imaging, scales and professional caregiver costs. Transition probabilities were 
estimated from clinical trials. The resource utilisation and unit costs were provided 
by a Delphi panel. According to the China Alzheimer’s project, there are 10 million 
dementia patients currently in the country and it is estimated that only 21.3% of 
them take medicine. Results: Over the five year, each untreated dementia patient 
cost on average 40,006 RMB per year, and each treated patient cost 36,503 RMB per 
year. Given current dementia patients of 10 million in China, and a treated prob-
ability of 21.3%, the annual total costs resulted in an economic burden of 392.6 
billion RMB per year for dementia patients in China. Because of the demographic 
evolution of the Chinese population, the number of dementia patients is expected 
to increase. Increasing the proportion of treated patients might be a way to limit 
the raise of the burden, as the treatment help to reduce the average annual health 
care costs. ConClusions: Burden of dementia in China is likely to grow since 
the expanding ageing population. Adequate disease management using available 
treatment may be an efficient solution to limit costs.
PMH12
eConoMIC Burden of deMentIa In sIngaPore: PrelIMInary results
Wang V.W.1, Kandiah N.2, Lin X.2, Wee H.L.1
1National University of Singapore, Singapore, 2National Neuroscience Institute, Singapore
objeCtives: With a rapidly ageing population, dementia has become a major public 
health problem worldwide. Around 28,000 Singaporeans aged 60 and above have 
dementia, and the number is projected to hit 80,000 by 2030, imposing a poten-
tially significant economic burden on individuals and society which has yet to be 
quantified. Therefore we sought to assess the annual economic burden of dementia 
in Singapore and to identify the main cost components. Methods: In this cross-
sectional study approved by the SingHealth Centralised Institutional Review Board, 
consecutive patients seen at the dementia clinic of National Neuroscience Institute 
(NNI) between August 2013 and December 2014 were recruited. Singapore residents 
meeting the National Institute of Neurological Disorders and Stroke criteria for the 
diagnosis of dementia with follow-up of at least 6 months at NNI were included. 
Caregivers of eligible patients were interviewed with a financial burden question-
naire to collect direct and indirect costs related to dementia over the past 12 months 
from a societal perspective. Results: Of 60 patients aged 54-91 years (median: 74) 
recruited, 90% were Chinese, 42% were men, and 38% had Young Onset Dementia 
(YOD) (defined as dementia onset before age 65). Annual total cost of dementia was 
SGD28341 per patient (i.e. $793 million for the country), with direct cost constituting 
23% and indirect cost constituting 77%. The main cost components for direct medical 
cost, direct non-medical cost, and indirect cost were pharmacotherapy (52%), home 
care (45%), and productivity loss (72%), respectively. As expected, the indirect cost 
of YOD patients was significantly higher than non-YOD patients. ConClusions: 
Dementia imposes a considerable economic burden in Singapore. As productivity 
loss accounts for a large share of the burden especially in YOD group, programs to 
improve early diagnosis, raise public awareness about the disease, reduce stigma 
and provide better support to caregivers are urgently needed.
PMH13
eConoMIC Burden of sCHIzoPHrenIa In CHIna: Based on MedICal 
InsuranCe dataBase froM guangzHou CIty
Huang Y.1, Liu G.2, Liu Y.H.1, Zhang H.3
1Peking University, Beijing, China, 2Guanghua School of Management, Peking University, Beijing, 
China, 3Sun Yat-sen University, Guangzhou, China
objeCtives: As reported by Chinese Center for Disease Control and Prevention in 
2009, there have been more than 10 million patients with schizophrenia in China, 
with the incidence of about 7.81‰. This article is to evaluate the economic burden of 
schizophrenia in Chinese city based on societal perspective and to detect its impact 
factors. Methods: 2010-2012 databases of Urban Employee Basic Medical Insurance 
and Urban Residents Basic Medical Insurance, as well as disability adjusted life year 
(DALY), were used to estimate direct cost and indirect cost caused by schizophrenia 
in Guangzhou, which is a large city in China with a population of over 8.5 million and 
the per capita GDP of approximately US$16,000. Results: During 2010-2012, direct 
costs of schizophrenia in Guangzhou city were RMB 95.69 million, 168.62 million, 
and 197.70 million (US$ 14.72 million, 25.94 million, and 30.42 million); indirect costs 
of schizophrenia were RMB 1,096.68 million, 1,201.89 million, and 1,375.08 million 
(US$ 168.72 million, 184.91 million, and 211.55 million). The ratio of direct economic 
loss to indirect economic loss was 1 to 8.5. Direct cost and indirect cost caused by 
schizophrenia in Guangzhou city were increasing in recent years. Medical costs 
of inpatients and people with Urban Employee Basic Medical Insurance mainly 
objeCtives: PERFORM-K (ePidEmiological Research on Functioning Outcomes 
Related to Major depressive disorder (MDD) in South-Korea) is a cross-sectional 
observational study conducted in South-Korea, with similar selection criteria and 
assessment to the PERFORM study in Europe. The main objective of the study is 
to describe the functioning of patients with MDD, the impact of cognitive dys-
function and the factors associated with functional impairment. Methods: 343 
outpatients were recruited by psychiatrists. Inclusion criteria were: DSM-IV-TR diag-
nosis of MDD, 19 to 65 years antidepressant monotherapy (initiation or first switch). 
Depression severity was evaluated with MADRS (Montgomery–Åsberg Depression 
Rating Scale) by psychiatrists and PHQ-9 (Patient Health Questionnaire 9-item) 
by patients. Functioning was measured by SDS (Sheehan Disability Scale), work 
productivity by WPAI (Work Productivity and Activity Impairment Questionnaire) 
and cognitive dysfunction by PDQ-D (Perceived Deficit Questionnaire-Depression). 
Descriptive analyses from functioning and activity questionnaires were comple-
mented with multivariate ANCOVA. Results: The 312 analyzable patients had a 
mean age of 45.2 years. 74.0% were women, 41.7% were employed and 22.8% had 
their treatment switched when visiting their psychiatrists. Mean MADRS and PHQ-9 
scores were respectively 28.9 and 16.0 respectively. Overall functioning was impaired 
(mean SDS= 16.7), as was overall activity (57.9% impairment on WPAI-4); 25.1% of the 
patients reported a PDQ-D score ≥ 44. In multivariate analyses, overall functional 
impairment (SDS) was associated with greater depression severity (p= 0.022), greater 
patient-reported cognitive dysfunction (p< 0.001), presence of sick leave in previous 
12-months (p= 0.004), younger age (p= 0.011) and region (p = 0.004). Overall activity 
impairment (WPAI-4) was associated with greater depressive severity (p= 0.043), 
greater cognitive dysfunction (p< 0.001) and younger age (p= 0.001). ConClusions: 
Functional impairment in MDD is not only associated with the severity of depres-
sion, but also with cognitive function, previous sick leave, age and region. This is 
consistent with findings from PERFORM in Europe.
PMH9
PrevalenCe of Major dePressIve dIsorder In CHIna
Low W.1, Azmi S.1, Li Y.2, Yee S.L.1, Abdat A.1, Kalita P.3, Ge L.2, Milea D.4
1Azmi Burhani Consulting, Petaling Jaya, Malaysia, 2Lundbeck China, Beijing, China, 3Lundbeck 
Singapore Pte Ltd, Singapore, 4Lundbeck Singapore Pte Ltd., Singapore
objeCtives: To review literatures that reported prevalence/incidence related to 
Major Depressive Disorder (MDD) in China. Methods: A structured literature 
review on published articles in both English and Mandarin language was con-
ducted. Search engines used for literature review were PUBMED, Cochrane Library, 
Wan Fang and VIP database.The review included primary studies or meta-analyses 
of prevalence or incidence studies of MDD published between 2000 and 2013 on 
Chinese population based in China only (including Hong-Kong and Macau). Four 
reviewers (two for each language) reviewed and extracted all relevant information 
from the selected articles. Results: One meta-analysis and 7 studies not included 
in the meta-analysis were identified. In the meta-analysis, the nationwide point 
prevalence of MDD was estimated to be 1.6% (95% CI: 1.2-1.9), 12-month prevalence 
to be 2.3% (95% CI: 1.8-5.5) and lifetime prevalence to be 3.3% (95% CI: 2.4-4.1). 
Point prevalence was higher in rural compared to urban areas. The other studies 
conducted across different regions reported point prevalence ranging from 3.6% 
to 9.4%, 12-month prevalence from 3.8% to 8.4% and lifetime prevalence of 6.5% to 
10%. A hospital-based study reported higher estimates (point prevalence of 7.5% 
and lifetime prevalence of 10%), possibly reflective of higher prevalence of MDD in 
patients with physical comorbidity or patients seeking help at hospitals. 11.0% to 
16.3% of patients with MDD were reported to have attempted suicide within 1 year, 
more frequently among patients from rural compared to urban area. About 27-28% 
of patient who committed suicide had history of MDD. ConClusions: The preva-
lence of MDD in China reported was variable between regions. The possible reason 
for this difference could be due to geographical and methodological differences. 
However, the reported prevalence was lower compared to that in western countries. 
Overall, the burden of MDD in China remains high due to its large population size.
Mental HealtH – Cost studies
PMH10
gloBal eConoMIC Burden of sCHIzoPHrenIa: a systeMatIC revIew
Chong H.Y.1, Chaiyakunapruk N.1, Wu D.B.C.1, Lee K.K.C. 2, Chiou C.F.3
1Monash University Malaysia, Selangor, Malaysia, 2Monash University, Kuala Lumpur, Malaysia, 
3Janssen Asia Pacific, Singapore
objeCtives: Schizophrenia is one of the most devastating mental illnesses. Despite 
low prevalence, health and economic consequences related to schizophrenia have 
been significant. Economic burden studies have been used to measure the mag-
nitude of the burden of this under-diagnosed and under-treated disabling condi-
tion to the society. To understand how previous studies on estimating economic 
burden of schizophrenia have been conducted, the present systematic review 
focuses on the methodology undertaken by these studies. Methods: Pubmed, 
EMBASE and PsycINFO were searched for publications from inception to October 
2013. Inclusion criteria were: (i) article measuring cost of schizophrenia; (ii) article 
reporting economic burden; (iii) information on the primary cost data was avail-
able; and (iv) article in English. Data from all eligible articles were extracted using 
a standardised data collection form. Costs were converted to 2013 USD. Results: 
Forty studies were included covering 24 countries – 12 countries (50%) in Europe. 
Almost half of the studies (55%) were conducted at selected institutions while 35% 
at the national level. Prevalence-based approach was adopted in 95% studies, while 
only 5% used incidence-based estimation. Costs were determined using bottom-
up (45%), top-down (33%) or combination of both (23%). Electronic databases (68%) 
and patient/family/health care provider (60%) were the main data sources used. 
The total annual direct medical costs reported in the national studies varied from 
USD 30 to 29,316 million and direct non-medical costs from USD 32 to 12,029 mil-
lion. Indirect costs ranged from USD 63 to 41,767 million per year, contributing to 


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PMH10 Global Economic Burden of Schizophrenia: A Systematic Review

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