Bipolar disorder cost in Tunisia

Background: Bipolar disorder is a frequent chronic illness characterized by its numerous recurrences and perpetuating cares. Aim: To evaluate the hospital annual direct cost of bipolar disorders as well as the impact of the compliance on this cost. Methods: 100 patients hospitalized between 1993 and 1998 in one of the services of the unique psychiatric hospital of the country have been included. These Patients met for DSM-IV bipolar disorders. The data collected have focused on the last year of patient follow-up. The hospitalization cost has been determined by adding to the forfeited hospitalizations, complementary examination expense. Similarly for ambulatory costs, we have added to the forfeited consultations, expense of medicines and complementary examinations. Results: Half of patients are male sex. The average age was 41 ± 11 years. Fifty two patients have been compliant (CO), partially compliant (PCO) and non compliant (NCO) constituted respectively 31% and 17%. The annual global cost of patients treated has been 780 ± 986 Tunisian Dinars (1TD = 1.2 US Dollars). The cost of the hospitalization constituted more than 2/3 of the global treatment cost. The average global cost has been lower for CO (411 ± 395 DT) and twice higher for the PCO (987 ± 966 DT) and four times more for the NCO (1533 ± 1307DT) (P < 0.001). This difference is imputed essentially to the hospitalization cost representing respectively 38.7%, 69.1% and 90.4% for CO, PCO and NCO. Conclusion: It is necessary to reduce this cost by decreasing the role of the hospitalization to the ambulatory processing profit and this by means of a psychiatric care decentralization and the training of first line physicians in psychiatric care.