Main findings
Our findings showed that OCD is a costly disorder associated with a low quality of life in China just as it is in more developed countries. The high national cost of OCD (estimated at US$5.34 billion (95% CI: US$4.94 to US$5.73 billion)) indicates that OCD is associated with a large economic burden for China. For the sensitivity analysis based on the prevalence of OCD, the total cost of Chinese patients with OCD was between US$3.27 billion (95% CI: US$3.03 to US$3.52 billion) and US$9.82 billion (95% CI: US$9.10 to US$10.55 billion). Based on the visit rate of OCD, the total cost of patients with OCD in China could even increase to US$52.33 billion. Social function status, combining psychiatric symptoms, Y-BOCS scores and age, were influencing factors for the quality of life of patients with OCD. The number of clinic and hospitalisation visits, socioeconomic status, education, Y-BOCS scores and age were found to be the factors significantly associated with the total cost.
Consistent with previous studies, the quality of life of patients with OCD in this study was also significantly impaired.17 18 Multiple domains of the quality of life appeared to be affected. In this study, the OCD’s emotional role was impaired the most. This indicates that emotional health is impaired more than physical health and may point to the need for more emotional support. The literature indicates that compared with healthy and community populations, patients with OCD have a lower quality of life.19 20 Although our study supports this finding, the extent of lower quality of life may be an underestimate as the quality of life was assessed after patients had received treatment. The regression models only explained 41.9% of the variation in SF-12 scores. This may be because the quality of life of patients with OCD is related to anxiety and depression symptoms21 22 and/or personality traits that were not assessed in this study.
OCD has not been regarded as a priority for the Chinese healthcare system. Quantifying the total economic cost of OCD can provide an important perspective on the social impact of OCD. Information on the cost of OCD could have a potential impact on China’s health policy and healthcare resource allocation decisions. The cost of OCD was 37.74 billion RMB (US$5.34 billion) and the estimated direct medical cost of OCD was 16.92 billion RMB (US$2.39 billion). The total cost of OCD represents about 0.3% of total national healthcare costs in China (16.92 billion RMB/6584.14 billion RMB).23 The direct medical costs per capita for OCD is 9787.77 RMB, which is more than double the per capita health expenditure in China (4702.79 RMB).24 The annual direct cost per OCD sufferer was US$1840.80 and indirect cost (predominantly lost productivity) was US$1384.41 in China. This is higher than the per capita direct cost of OCD and lower than the indirect cost of OCD in the USA.25 However, these studies from the USA require updating as they were published in 1990, that is, 30 years ago.
Compared with the cost of mental disorder in China, the cost of OCD is lower than that of depression (51.37 billion RMB).The cost of depression in 2002 showed that the direct cost per capita was 8090 RMB and the indirect cost per capita was 43 280 RMB.26 After adjusting the price index, the direct cost of OCD is not much different from that of depression, but it is much lower than the indirect cost. The cost of OCD is not much different from the cost of schizophrenia, but the direct cost is higher than that of schizophrenia.27 The burden of OCD is significant for patients and their families, just as for other mental disorders, hence advocacy is required to ensure that governments and policymakers consider the costs of OCD when allocating health resources.
The direct cost per patient with OCD in this study was 55.05% of the total costs and this finding is different from the study in the USA, where the indirect burden of OCD was estimated to be higher at 71% of the total costs. Explanations for this discrepancy may be related to our use of human capital method to estimate the loss of productivity and higher costs of psychiatric medicine in China as psychotropic drugs are imported to China. Data for family household costs have revealed average annual direct medical costs of 6858.68 RMB and average annual indirect costs of 14 268.03 RMB. Compared with the social cost of OCD, the direct medical costs have been reduced by an average of 3271.84 RMB and the indirect costs have increased by an average of 3254.52 RMB. The reduction in direct medical costs paid by households is owing to a partial reimbursement from the China’s insurance mechanism though the reimbursement is limited, merely 32.30% on average. The increase in indirect costs of families in China is mainly caused by the parents of patients with OCD, who are also the main provider of the households. Since parents of some patients with OCD work longer hours, have more production skills and higher positions, their labour loss days were more costly for the family. The increase in indirect costs of OCD is significant for families of patients with OCD in China because families provide major financial and emotional support.
Limitations
This study is the first attempt to estimate the economic consequences of OCD in China. The study has a number of limitations. First, our series was not a randomly selected sample. Our sample may not be representative of the whole of China, but our sample was basically similar to some of the epidemiological characteristics of OCD. For example, the psychiatric symptoms of patients with OCD were almost all depression and anxiety, which were 16.4% and 7.1%, respectively. Depression and anxiety are comorbidities of the normalisation of OCD, and the combined prevalence was similar to the comorbidity of OCD.28 29 Second, the costs are estimated from the personal interview data of those who sought treatment. Patients with OCD who rarely attend for treatment or death cases are not included. Finally, owing to the lack of some mental healthcare information about OCD (such as OCD visit rate), uncertainty exists within the estimates of the cost of OCD.
Implications
OCD is associated with a low quality of life and is a costly disease in China. Government policymakers should seriously consider further investments in mental health services. In addition to the impact of quality of life and income, OCD also impacts significantly on the physical and mental health of the patient and their family members, resulting in less well-measured non-economic impacts. The burden of OCD is significant and more studies are needed to enhance our understanding of this burden.