Autori: Marzia Bonfanti, Emi Bondi, Giovanni Fabbrini, Giuseppe Nicolò, Michele Tinazzi, Antonio Vita, Marianna Morani, Andrea Vitagliano, Giacomo Zavaroni, Andrea Fagiolini
Tardive dyskinesia (TD) is a persistent and often irreversible movement disorder caused by prolonged exposure to dopamine receptor-blocking agents, particularly antipsychotics. Despite its clinical relevance, TD remains underdiagnosed – especially in its mild forms – hindering prevalence estimation and delaying appropriate treatment.
This study aimed to quantify the economic burden of TD in Italy through a cost-of-illness (COI) analysis from the perspective of the Italian National Health Service (NHS). A prevalence-based model was developed using a Sum Diagnosis approach, focusing on patients with TD secondary to schizophrenia, bipolar disorder, and major depressive disorder. Direct medical costs were estimated based on disease severity (mild vs. moderate-severe), expert-validated resource utilization, and official NHS tariffs. Estimates were model-based and derived from published evidence integrated with expert opinion to define epidemiological assumptions and healthcare resource utilization patterns.
The total annual direct medical cost of TD in Italy was estimated at € 62.7 million, with a mean cost per patient of € 4,427. Moderate-severe cases represented 95% of the total burden. Hospitalizations were the leading cost driver (46%), followed by outpatient services (22%) and pharmacological therapies (16%). Schizophrenia accounted for 62% of total costs, bipolar disorder for 34%, and major depressive disorder for 4%.
A one-way deterministic sensitivity analysis was performed, varying key unit cost and epidemiological parameters by ±20%, a standard range in COI studies. Total costs ranged from € 50.9 million to € 74.5 million. Hospitalization costs and the proportion of moderate-severe cases had the greatest impact on results, though no parameter shifted total costs by more than 20%, confirming model robustness.
These findings underscore the substantial yet underrecognized burden of TD on the Italian healthcare system. Improving early diagnosis and expanding access to effective, reimbursed therapies could reduce both the clinical and economic impact of this chronic, treatment-related disorder.
Keywords
tardive dyskinesia, economic burden, cost-of-illness analysis, national healthcare service.
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Cost-of-Illness Analysis of TD in Italy
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