4th Johore Mental Health Convention 23 - 24 August 2002 Hyatt Regency Hotel Johor Bahru COST-EFFECTiVENESS STUDY OF MANAGEMENT OF SCHIZOPHRENIA AT THREE DIFFERENTS LEVELOF PSYCHIATRIC CARE IN MALAYSIA Syed Aljunid; Mazlan A., Aziz AA.,Daud MD. and Ismail D.  Syed Mohamed Aljunid, MD, PhD, FAMM. Department of community Health, National University Malaysia  Mazlan Abdullah, MD, MComH Department of Community Medicine, Science University Malaysia  Abdul Aziz Abdullah, MBBS, MPM, MPH. Mohd Daud Dalip, MD, M.Psych. Med. lsmail Drahman, MBBS, M.Psych. Med. Department of Psychiatry, Kuala Lurnpur Hospital A research to study the cost-effectiveness of management of schizophrenic was undertaken at three different level of psychiatric care in Malaysia. Cases were selected from three District Hospitals, three General Hospitals and two Mental Institutions for nine months starting April 2000 to December 2000. Cost analysis was conducted from the perspectives of the provider and patients. The research team used Health of The Nation Outcome Scale (HONOS) to measure outcomes on patient discharged from the wards. Total of 665 cases were recruited in the study, 200, 241, 224 cases from District Hospitals, General Hospitals and Mental Institutions respectively. Result: The patients’ cost, provider’s cost .and total cost differed significantly (p<0.OO 1) in the three level of care. The mean cost for the provider was RM2,47 1.13, RM3,362.40, and RM2O,775.80 per year for District Hospital, General Hospital and Mental Institution respectively. The means cost from the perspectives of patients was RM1 6,405.16, RM16, 165.66, and RMI4,683.37 per year for District Hospital, General Hospital and Mental Institution respectively. The means for total cost were RM 18,876.28, RM 19,528.06, and RM35,459.16 per year for District Hospital, General Hospital and Mental Institution respectively. Level of care, length of stay and ethnic group of patients were important predictors for provider’s cost while length of stay, job status and case category were good predictors for patients’ cost. The ‘overall total costs were influenced by level of care and case category. Mean of outcome measurement was 42.11 units, 38.61 units, and 37.73 units at District Hospital, General Hospital and Mental Institution respectively and were significantly different (p<O.00 I). The cost-effectiveness ratio was RM527.90, RM534.29 and RM857.90 per outcome unit for District Hospital, General Hospital and Mental Institution respectively were significantly different (p<O.00 I). Conclusions: The study shows treating schizophrenias at District Hospital and General Hospital were more cost-effective compared to Mental Institution. Cost for treating schizophrenia is estimated RM1 billion a year equivalents to 7.0% of national expenditures in health sector. Reevaluation of Mental Institution roles in treating schizophrenias should be a Ministry of Health agenda in the future. District and General Hospitals should be given more financial allocation and higher level of staffing to manage schizophrenia and mental illness.