Gastos de bolsillo por gastroenteritis a causa de rotavirus en el Hospital Pediátrico de Cienfuegos, 2019 - 2020 / Out-Of-Pocket Expenses for Gastroenteritis Due to Rotavirus at Cienfuegos Pediatric Hospital, 2019 - 2020

Introducción: La hospitalización por enfermedades diarreicas agudas en menores de cinco años de edad puede generar gastos importantes para la familia. Objetivo: Estimar el gasto de bolsillo y el costo indirecto por la atención a pacientes menores de cinco años de edad hospitalizados por gastroenteritis a causa de rotavirus. Métodos: Estudio de descripción de costos. Se empleó el microcosteo para estimar el costo directo médico (servicio y medicamentos) y no médico (transporte, alimentación, aseo), así como las pérdidas de productividad para el paciente y su familia y las fuentes de financiamiento. Se trabajó con 132 pacientes hospitalizados en el Hospital Pediátrico de Cienfuegos entre septiembre de 2019 y febrero de 2020 con gastroenteritis y test rápido de rotavirus positivo. El gasto se analizó según la situación económica referida y la edad del paciente. Resultados: La media del gasto de bolsillo total fue de CUP 809,66 (IC 95 por ciento 757,57 - 861,75); el 50,8 por ciento por alimentación, el 31,4 por ciento por aseo y un 17,8 por ciento por transportación. Los hogares con mejor situación económica gastaron más (< 0,001). El 87,2 por ciento de las familias utilizó alguna fuente de recursos adicional a sus ingresos habituales. Se afectaron 2,39 personas (IC 95 por ciento 2,27 - 2,52) y se reportó una pérdida de 5,51 días laborales (IC 95 por ciento 5,21 - 5,8). El costo indirecto promedio fue de CUP 418,8 (IC 95 por ciento 382,36 - 455,24). Conclusiones: La hospitalización de un menor de cinco años por gastroenteritis aguda a causa de rotavirus en Cienfuegos significa una carga económica considerable para los hogares, en especial para los de mejor situación económica(AU)

Introduction: Hospitalization for acute diarrheal diseases in children under five years of age can generate significant expenses for the family. Objective: To assess the out-of-pocket expense and the indirect cost for the care of patients under five years of age hospitalized for gastroenteritis due to rotavirus. Methods: This is cost description study. Microcosting was used to estimate the direct medical cost (service and medication) and non-medical cost (transportation, food, cleaning), as well as the productivity losses for patients and their family and the sources of financing. We worked with 132 patients hospitalized at Cienfuegos Pediatric Hospital from September 2019 to February 2020 with gastroenteritis and a positive rotavirus rapid test. Expenditure was analyzed according to the economic situation referred to and the age of the patient. Results: The mean total out-of-pocket expense was CUP 809.66 (95percent CI 757.57 - 861.75); 50.8percent for food, 31.4percent for cleaning and 17.8percent for transportation. Households with better economic situation spent more (<0.001). 87.2percent of the families used some source of resources in addition to their usual income. 2.39 people were affected (95percent CI 2.27 - 2.52) and a loss of 5.51 working days was reported (95percent CI 5.21 - 5.8). The average indirect cost was CUP 418.8 (95percent CI 382.36 - 455.24). Conclusions: The hospitalization of a child under five years of age for acute gastroenteritis due to rotavirus in Cienfuegos represents a considerable economic burden for families, especially for those with better economic situation(AU)

Patient treatment cost of oral diseases in Ghana

Objectives: To estimate patient treatment cost of oral diseases in Ghana Design: A cross-sectional study design using cost-of-illness analysis was employed Setting: The study was conducted at the dental unit of the University of Ghana Hospital, Legon Participants: About185 patients attending the dental unit of the hospital were selected Interventions: None Main outcome measures: Direct medical and non-medical costs, indirect costs, and intangible costs of treatment of oral conditions Results: The estimated average cost of treatment for oral diseases was US$ 35.75. The total cost was US$ 6,614.11, with the direct and indirect costs constituting 94.5% and 5.5%, respectively of the total cost. Direct medical costs constituted 86.9%, while direct non-medical costs constituted 13.1% of the total direct cost. The richer socio-economic group had the highest cost per quintile, with a mean of US$ 46.69. The intangible cost described was highest for pain (47.1%), followed by difficulty in eating (40.8%) and sleeping (34.6%) for both men and women. Conclusion: The costs of oral diseases are huge and cannot be overlooked. Oral diseases also pose significant productivity losses to patients

Evaluación económica de las alternativas terapéuticas en pacientes con hiperestesia dentinaria / Economic evaluation of the therapeutic alternatives in patients with dentin hyperesthesia

Introducción: La hiperestesia dentinaria es una sensación dolorosa de intensidad variable, que va de leve a moderada y, al encontrarse la dentina expuesta, puede convertirse en una molestia constante. Objetivo: Determinar la alternativa menos costosa en el tratamiento de pacientes con hiperestesia dentinaria. Método: Se realizó una evaluación económica completa del tipo minimización de costo, en la Clínica Estomatológica Provincial Docente Mártires del Moncada de Santiago de Cuba, desde enero hasta mayo de 2019. Se revisaron 40 historias clínicas, escogidas a conveniencia, ya que contaban con los datos necesarios para la investigación. Se crearon 2 grupos de estudios, cuyos integrantes fueron tratados con laca flúor y láser, respectivamente. Se analizaron las variables de edad, sexo, efectividad de los tratamientos, costo directo e indirecto y costo unitario. Resultados: En la serie predominaron el grupo etario de 15-24 años (30,0 %), seguido por el de 25- 34 (25,0 %), así como el sexo femenino (70,0 %). El costo unitario del tratamiento con laca flúor fue de $7,77 y con láser de $5,74, para una diferencia de $2,03. Conclusión: La alternativa menos costosa en el tratamiento de pacientes con hiperestesia dentinaria resultó ser la aplicación de láser; mientras que la evaluación económica realizada demostró ser apropiada en materia de eficiencia económica.

Introduction: Dentin hyperesthesia is a painful sensation of variable intensity that goes from light to moderate and, as dentin is exposed, it can become a constant discomfort. Objective: To determine the less expensive alternative in the treatment of patients with dentin hyperesthesia. Method: A complete economic evaluation of the cost minimization type was carried out in Martires del Moncada Teaching Provincial Stomatological Clinic in Santiago de Cuba, from January to May, 2019. Forty medical records were reviewed, chosen of convenience, since they had the necessary data for the investigation. Two groups of studies were created whose members were treated with lacquer fluorine and laser, respectively. The age, sex, effectiveness of the treatments, direct and indirect cost and unitary cost variables were analyzed. Results: In the series there was a prevalence of the 15-24 age group (30.0 %), followed by that of 25-34 (25.0 %), as well as the female sex (70.0 %). The unitary cost of the treatment with lacquer fluorine was of $7.77 and with laser of $5.74, for a difference of $2.03. Conclusion: The less expensive alternative in the treatment of patients with dentin hyperesthesia was the laser application; while the economic evaluation carried out demonstrated to be appropriate as regards economic efficiency.

Assessment of out-of–pocket health expenditure and prevalence of protective mechanisms against it among the households in an urban area, Bangalore: a longitudinal study

Background: Achieving Universal Health Coverage according to The World Health Assembly’s way to reinforce the principle of human right to health in 2005 has been a huge task for India. India has one of the highest proportions of household out-of-pocket expenditures on health in the world, estimated at 71.1% in 2008–09. The unpredictable payments are impoverishing an estimated 3.3% of India's population every year. In this regard various strategies have been adopted such as—reforming tax based health financing or introducing health insurance. This highlights the need for alternative finances which includes the provision of medical insurance. The study was conducted to assess the out-of-pocket health expenditure and estimate the prevalence of protective mechanisms against it in an urban area- Bangalore.Methods: A longitudinal study was conducted in the urban area of Bangalore. Sample size was calculated to be 350 households. Data regarding socio-demographic profile, protective mechanisms and other details were obtained by interview method using a pre-tested and semi-structured questionnaire.Results: Majority were in the productive age group i.e. 991 (62.68%) individuals. Female population was slightly higher in our study. Most of the households belonged to upper lower class (54.29%). A major burden of health care cost was experienced both in acute as well as chronic illness by the households. Only 8.9% (31 households) had one or the other type of health insurance.Conclusions: Population has profound chances of experiencing catastrophic health expenditure in times of severe illness.

An Empirical Analysis of Costs related to Nursing Practice / 간호행정학회지

PURPOSE: The purpose of this study was to identify nursing service costs associated with all health care costs incurred by the institution. METHODS: This study was an empirical case study research in which the nursing cost was separated from total medical cost. The nursing cost index was calculated through a cost allocation method after summarizing costs for personnel, raw materials and administration of each department in one public hospital. The 2014 budget plan, published in ‘Public Hospitals Alert’, was used as data and the data were analyzed using the Microsoft Office EXCEL 2013 program. RESULTS: When comparing total medical costs and nursing costs, the nursing cost were 27.14% of the total medical cost. The nursing cost per nurse per hour was calculated as ₩29,128 The nursing cost per inpatient per day was calculated as ₩157,970, and the administration cost per patient was calculated as ₩133,710. CONCLUSION: The results of the research present the process of cost allocation of specific cost elements in the hospital and evidence for administrative costs which in the past have been only vaguely formulated. These are the significant implications of this study.

Out-of-pocket expenditures of Maternity Services at a Tertiary Level Hospitals in Western, Nepal

​Government of Nepal revised free maternity health services “Aama Surakshya Karyakram” since the start of Fiscal Year 2012/13 with specifies the services to be funded, the tariffs for reimbursement and the system for claiming and reporting on free deliveries each month. This study was designed to investigate the amount of money expenditure incurred by families in using apparently free maternity services. It was a hospital based cross-sectional study conducted at Manipal Teaching Hospital and Western Regional Hospital. Nepalese women’s were not involved in the family finance and had very little knowledge of income or expenditure. That’s why face to face interviewed among 384 post-partum mothers with their husband or house head of family were conducted at the time of discharge by using a pre-tested semi-structural questionnaire. The average monthly family income was 19272.4 NRs (189.01 US$). The median duration of hospital was 4 days (2-19 days). The median patient’s expenditure was equivalent to 13% of annual family income. The average total visible costs was 3887.07 NRs (38.1 US $). When the average total hidden cost 27288.5 NRs (267.6US $) was added then the average total maternity care expenditures was 31175.6 NRs (305.76 US $). Average-cost-per-day was 7167.5 NRs (70.29 US$). The mean patient's expenditure on the food and drinking, clothes, transport and medicine were equivalent to 53.07%, 9.8%. 7.3% and 5.6% of mean total maternity care expenditure respectively. 5963.7 NRs (58.4 US$), 7429.3 NRs (72.9 US$) and 6175.9 NRs (60.6 US$) were lost earning of women, husband and House head respondents respectively. A free maternity service in Nepal has high out-of-pocket expenditures and it was more than average monthly income for most families. Therefore, arrange of medicine by the hospital in the free of cost which were not included in essential drug during the hospital stay and at the discharge time. Similarly, arrange for liquid food and hot water as well as clothes for mothers and newly born baby by the hospital to enhance the hospital attendance.

Health care seeking behaviour and expenditure pattern among Scrub Typhus patients attending a tertiary care hospital in Mysore city.

Background: Scrub typhus is one among the re-emerging infectious diseases throughout the world. Various studies conducted across India reveals that its public health importance is increasing. This study was conducted 1) To describe the socio-demographic and epidemiological profile of patients admitted with scrub typhus. 2) To assess the health care seeking behaviour of these patients. 3) To estimate the cost factors incurred in the current episode of illness. Methods: This prospective study was conducted from January to December 2013 among all lab confirmed cases of scrub typhus admitted to department of medicine and pediatrics of JSS Hospital, Mysore. The study subjects were interviewed with a pre-tested and structured questionnaire. Data regarding socio-demographic profile, epidemiological profile, disease outcome, health care seeking behaviour and cost factors incurred with current episode of illness were collected. Data entry and analysis were done with SPSS.v.22.0 using descriptive statistics like mean, standard deviations and inferential statistics like chi-square test. Results: Among 192 patients tested positive by Weil-Felix test and/or Immuno-Chromatographic Test (ICT) for scrub typhus majority 105 (54.7%) were males and were predominantly 135 (70.3 %) from rural areas. Mostly 172(89.6%) were unaware of any mite bite in the past. Majority 167 (87.0%) of them had visited atleast three Health Care Facilities (HCF) for treatment. The mean ± SD total duration of illness was 15.6 ± 4.1 days. Most 104 (54.2 %) of them had suffered from illness for 11-15 days. Majority 175 (91.1%) of them had recovered while 3 (1.6%) of them had succumbed to the condition. The median Total direct cost, total indirect cost and overall total cost were Rs. 7500 (7000-9500), Rs. 3000 (2500-3500) and Rs. 10500 (10000-13000) respectively. Most 104 (54.2%) of them spent from money borrowed from others, followed by 78 (40.6%) spent Out Of Pocket (OOP). Conclusion: People from rural areas, unskilled workers and children were affected predominantly. With timely diagnosis and appropriate treatment, significant morbidity and mortality could be prevented. Promotion of various public and private health insurance schemes among public would minimise the OOP expenditure and prevents debts.

Indirect costs in the treatment of Tuberculosis under DOTS.

Introduction: Tuberculosis (TB) causes enormous social and economic disruption and hampers nation’s development. DOTS strategy under RNTCP is one of the largest public health programes found to be beneficial against TB. The key component of DOTS is that each dose during continuous phase of treatment should be administered to patients under the supervision of a DOT provider, either from the community or the health system. This may sometime leads to loss of wages or incurs transportation charges for treatment in the program. Material and methods: A cross sectional study was conducted in 2 randomly selected DOTS centre of Jalandhar. Total number of patients registered during third quartile of 2014 was 107, out of which 102 patients can be contacted. Information regarding indirect costs i.e. wage loss, expenditure on transportation and extra nutrition was collected from all the patients. The data so collected was entered in analyzed using SPSS 16 software. Results: Overall mean expenditure of category 1 and 2 patients treated under DOTS was Rs 2072/- and 2319/- month. The major share of indirect costs (3/4 th) can be attributed to wage loss due to decreased capacity to work or work absenteeism. Majority of the patients (79%) preferred to take additional nutrients, which contributes to around one fourth of the total indirect costs. Travel costs as means of indirect expenditure were minimal (1.5%). Conclusion: Around half of the patients had undergone decrease in their monthly income. The major share of indirect costs (74%) can be attributed to wage loss due to decreased capacity to work. Recommendations: The patients registered under RNTCP should be covered under some food subsidy schemes with the help of Government sector/ NGOs. Patients unable to continue with their jobs should be assisted by social security schemes/ insurance coverage.

Estimating the Economic Burden of Malaria and Assessing Its Relationship with Socio-Economic Condition in Rohtak and Mewat Districts of Haryana, India.

Aim: Malaria continues to remain a serious public health problem and causes significant economic burden especially among the poor tribal and marginalised communities in the tropical and subtropical countries of the World. In view of the lack of information in respect of malaria and economic losses in Haryana, an attempt was made to assess the relationship between the occurrence of malaria and socio-economic conditions as well as to estimate the direct and indirect costs incurred due to malaria in Rohtak and Mewat districts of Haryana. Methodology: A community based cross-sectional survey was carried out in a highly malaria endemic cluster of six selected villages of Rohtak and Mewat region of Haryana, to estimate the economic burden in terms of direct and indirect costs of malaria. Results: The study revealed that on an average a household incurred a total cost of Rs.1835 (29.77 US$) in Rohtak district and Rs 2027 (32.91 US$) in Mewat district as direct and indirect cost per patient. It was estimated that direct costs due to malaria consumed 36-40% of annual income of poor households and 3-4% of high income households suggesting that the burden of malaria is significantly higher among poor households. Conclusion: The study revealed that malaria posses a significant economic burden on poor households both through out-of-pocket expenditure and man-days lost. To reduce the economic burden of malaria implementation of suitable intervention measures with focus on poor and marginalised along with better allocation of resources and health care facilities at the Government hospitals must be taken into consideration. It is also needed the intensification of IEC (Information, Education and Communication) campaigns regarding malaria to enhance awareness and solicit community participation.

Cost-of-Illness Trends Associated with Thyroid Disease in Korea

BACKGROUND: The purpose of this study is to analyze the scale of and trends associated with the cost-of-illness of thyroid disease in Korea at 2-year intervals during the last 10 years for which data are available. METHODS: Cost-of-illness was estimated in terms of direct and indirect costs. Direct costs include direct medical costs due to hospitalization, outpatient and pharmacy sectors, transportation, and care-giver costs. Indirect costs include future income loss due to premature death and loss of productivity as a result of absence from work. RESULTS: The cost-of-illness of thyroid disease in Korea was estimated at 224.2 billion won in 2002, 303.4 billion won in 2004, 400.3 billion won in 2006, 570.4 billion won in 2008, and 762.2 billion won in 2010. For example, the cost-of-illness of thyroid disease in 2010 was 3.4 times greater compared to 2002. The direct cost of the total cost-of-illness was 69.7%, which accounted for the highest proportion of costs. Cost-of-illness for individuals between the ages of 30 and 50 accounted for the greatest share of costs. CONCLUSION: The cost-of-illness of thyroid disease was relatively large in economically active age groups, and demonstrated a very rapid growth rate compared to other major diseases in Korea. Therefore, we suggest nationwide recognition of the importance of prevention and management of thyroid disease and prioritization of the management of thyroid disease among current and future health promotion policies in Korea.

Custos diretos e indiretos da asma: revisão de literatura / Direct and indirect costs of asthma: a review

Objetivo: Realizar revisão da literatura sobre análises econômicas utilizadas para a asma, os custos diretos e indiretos, tendo em vista a sobrecarga econômica que essa doença acarreta para o sistema de saúde. Fonte de dados: Pesquisa de artigos originais, revisões e consensos, indexados nos bancos de dados Medline, Lilacs, Embase e Pubmed, publicados entre 1996-2012. Síntese dos dados: A asma é uma doença pulmonar inflamatória crônica que acomete pessoas de todas as idades, cujo descontrole leva a hospitalizações frequentes, visitas à emergência e aumento na morbidade, gerando grande impacto na vida social e econômica dos pacientes, com piora da qualidade de vida. A partir dos programas de controle da asma e rinite alérgica e da dispensação de medicamentos de alto custo, houve significativa queda das hospitalizações por asma no período de 2006 a 2010. Em 2012, implementou-se o “Programa Saúde não tem Preço”, ação integrante do “Programa Farmácia Popular” do Ministério da Saúde (MS), com fornecimento gratuito de brometo de ipratrópio, diproprionato de beclometasona e sulfato de salbutamol. Com este programa, houve crescimento significante de 443% no número de asmáticos beneficiados, aumentando de 48.495 para 263.227 pessoas. Os dados do MS apontaram que a asma ainda causa a morte de 2,5 mil pessoas por ano no Brasil. Em 2011 do total de 117,8 mil internações no Sistema Único de Saúde (SUS) em decorrência da asma, 77,1 mil acometeram crianças na faixa etária de 0 a 6 anos. A asma ainda representa um importante problema global de saúde pública com elevados custos diretos e indiretos, que oneram de forma expressiva os pacientes e os sistemas públicos de saúde. Conclusão: Os programas implementados proporcionaram melhora da saúde dos indivíduos, tornando-os mais aptos ao trabalho, aumentando a produtividade e reduzindo significativamente os custos para a sociedade

Objective: To review the literature on economic analyzes used for asthma, the direct and indirect costs and the economic burden that this disease poses to the health system.Source of data: Survey of original articles, reviews and consensus, indexed in Medline, Lilacs, Embase and PubMed, published between 1996-2012. Data Synthesis: Asthma is a chronic inflammatory lung disease that affects people of all ages, whose lack leads to frequent hospitalizations, emergency room visits and increased morbidity, generating great impact on social and economic life of patients with worsening quality of life. After the beginning of asthma and allergic rhinitis control programs with free delivery of expensive drugs expensive, there was a significant drop in hospitalizations for asthma in the period from 2006 to 2010. In 2012, 48,495 people had access to drugs for asthma, from the implementation of the “Health Program”, integral action of “Popular Pharmacy Program” of the Ministry of Health (MH), with free supply of ipratropium bromide, beclomethasone dipropionate and salbutamol sulphate, this number increased signifcantly from 48,495 to 263,227 people, representing growth of 443% adherence to the program. The MH data showed that asthma still kills 2500 people a year in Brazil, in 2011 the total of 117,800 hospitalizations in the Unified Health System (UHS) due to asthma were affected 77.1 thousand children aged 0-6 years. In addition, asthma is an important global public health problem with high direct and indirect costs, which affect expressively patients and public health systems. Conclusion: The programs implemented provided improves the health of individuals, making them more apt to work, increasing productivity and significantly reducing costs to society

Economic Burden of Schizophrenia in South Korea

This study estimates the treated prevalence of schizophrenia and the annual costs associated with the illness in Korea in 2005, from a societal perspective. Annual direct healthcare costs associated with schizophrenia were estimated from National Health Insurance and Medical Aid records. Annual direct non-healthcare costs were estimated for incarceration, transport, community mental health centers, and institutions related to schizophrenia. Annual indirect costs were estimated for the following components of productivity loss due to illness: unemployment, reduced productivity, premature mortality, and caregivers' productivity loss using a human capital approach based on market wages. All costs were adjusted to 2005 levels using the healthcare component of the Consumer Price Index. The treated prevalence of schizophrenia in 2005 was 0.4% of the Korean population. The overall cost of schizophrenia was estimated to be $ 3,174.8 million (3,251.0 billion Won), which included a direct healthcare cost of $ 418.7 million (428.6 billion Won). Total direct non-healthcare costs were estimated to be $ 121 million (123.9 billion Won), and total indirect costs were estimated at $ 2,635.1 million (2,698.3 billion Won). Unemployment was identified as the largest component of overall cost. These findings demonstrate that schizophrenia is not rare, and that represents a substantial economic burden.

Pharmacoeconomic Evaluation of Long-term Treatment with Typical and Atypical Antipsychotics for Patients with Chronic Schizophrenia / 신경정신의학

OBJECTIVES: We aimed to compare clinical outcomes, work status and total costs of care associated with typical and atypical treatment in patients with schizophrenia. METHODS: Cost data for services and prescription use were retrieved retrospectively for 40 and 27 patients with schizophrenia who were initiated on typical or atypical antipsychotics after registration in 1994 and 2000, respectively. Each patient was followed for 3 year after initiation of therapy. Direct and indirect cost were calculated for both groups and analyzed by SAS 8.2. RESULTS: There was not significant difference in clinical outcomes between two groups except the number of admission was higher in typical antipsychotics group (p<0.05). As for direct cost, patients prescribed on atypical antipsychotics have paid almost two-fold more than typical groups. However, the proportion of unemployment was higher in typical group than in atypical group, leading to much loss of productivity. Therefore, considered offset by lower indirect costs, total costs per patients over the study were 19% higher in typical treatment group than in aytpical treatment group. CONCLUSIONS: Atypical antipsychotics were estimated to be of advantage over typical antipsychotics, by offsetting the big difference of medication cost between two classes.

Socioeconomic Cost of Obesity in Korea

With dramatic transitions from a traditionally food-insecure to a food-sufficient society, over weight and/or obesity are an increasing health concern in Korea. In 2000, 35.9% of Korean adults were over weight (BMI>25) with increasing trends. It is well known that obesity is highly correlated with chronic diseases, such as diabetes, hypertension, cardiovascular disease, cancer and high cholesterol. In 2003, the social cost of obesity is estimated at 529.5~799.3 billion won (direct cost) and at 1,200~1,817 billion won (including indirect cost). The share of the direct cost is estimated at 2.6~3.9% of total medical bill 20,742 billion won. These costs are underestimated and would surely be higher if the expenditures outside of the official medical insurance system of Korea were included. Based on the rapid increase of obesity rate among the Korean youth, it is crucial to develop and implement appropriate policies to curb the obesity epidemic.

Direct and Indirect Cost of Treating Out-Patients with Schizophrenia in Korea / 신경정신의학

OBJECTIVES: We have aimed to estimate the direct and indirect costs of treating out-patients with schizophrenia in Korea, to use this fundamental data for the effective management and proper distribution of the medical resource. METHOD: To estimate the direct cost, we surveyed the medical cost and time of two hundred and eighty-nine out-patients with schizophrenia for six months. And the lost productivity as many months was converted into the indirect cost. Those of eighty-two coronary heart disease patients were also estimated as a comparison group. RESULTS: An unemployement rate of schizophrenic patients was 72.1 percent. Moreover the ratio of the laborer in the sample was, even if employed, 64.5 percent. The mean direct cost of schizo-phrenic patients was, about 815,000 won, higher than that of coronary heart disease, 715,000 won however it was not statistically significant. The former was also estimated 2.5 times more than the latter for the indirect cost, or 6,456, 000 won versus 2,589,000 won. CONCLUSION: Schizophrenia is a relatively costly illness compared to other chronic illness, so the systematic estimation of the cost is necessary to provide mental health service of high quality.