Health Care Utilization and Costs among Medicaid-enrolled Patients with Schizophrenia Experiencing Multiple Psychiatric Relapses

ObjectiveThis study compared all-cause and schizophrenia-related health care utilization and costs among patients with schizophrenia using second-generation oral antipsychotics (SGOAs) and experiencing ≥2 psychiatric-related relapses with those experiencing <2 relapses.Study DesignPatients with schizophrenia who initiated SGOA therapy were identified in the MarketScan® Medicaid Multi-State database between July 1, 2004 and December 31, 2007. Patients were stratified by <2 psychiatric-related relapse events and ≥2 psychiatric-related relapse events during the 12-month period following SGOA initiation. All-cause and schizophrenia-related health care utilization and costs were estimated for each cohort in various care settings. Univariate and multivariate regression analyses were conducted to assess the differences in all-cause and schizophrenia-related health care utilization and costs between the 2 cohorts. No adjustments were made for multiple inferential statistical tests.ResultsThe cohort consisted of 19,813 patients, of whom 3714 (18.75%) had ≥2 psychiatric-related relapse events during the follow-up period. On average, patients with ≥2 psychiatric-related relapse events were younger than patients with <2 psychiatric-related relapse events (42.62 years vs. 44.21 years; P < 0.001), and the all-cause and schizophrenia-related inpatient costs were approximately 12 and 23 times higher, respectively. The mean covariate-adjusted predicted schizophrenia-related total medical costs per patient were significantly higher among patients with ≥2 psychiatric-related relapse events than among patients with <2 psychiatric-related relapse events ($17,910 vs. $10,346; P < 0.001).ConclusionPatients who received an SGOA and experienced ≥2 psychiatric-related relapse events within the first year of treatment incurred significantly greater all-cause and schizophrenia-related total medical costs than those with <2.