Cost of Relapse in Schizophrenia

Abstract

To estimate the national annual cost of rehospitalization for multiple-episode schizophrenia outpatients, and to determine the relative cost burden from loss of medication efficacy and from medication noncompliance, the yearly number of neuroleptic-responsive multiple-episode schizophrenia inpatients in the United States who are discharged back to outpatient treatment was estimated. The cohort at risk for future relapse and rehospitalization was determined. The research literature on the expected rates of relapse for schizophrenia patients on maintenance antipsychotic medication was reviewed; in particular, monthly relapse rates under the optimal medication conditions of compliant patients taking optimal doses of a depot neuroleptic (optimal neuroleptic dose) and under the less optimal conditions of patients stopping medication (medication noncompliant) was estimated. Using established noncompliance rates from the literature, it became possible to estimate a "real world" rehospitalization rate for this cohort, as well as the relative burden accruing from loss of medication efficacy and from medication noncompliance. Finally, cost estimates for index hospitalizations and rehospitalizations were derived from data on national expenditures for inpatient mental health care. The monthly relapse rates are estimated to be 3.5 percent per month for patients on maintenance neuroleptics and 11.0 percent per month for patients who have discontinued their medication. Postdischarge noncompliance rates in community settings are estimated to be 7.6 percent per month. These estimates were entered into a survival analysis model to determine the real world relapse rate of this cohort. An estimated 257,446 multiple-episode (> or = two hospitalizations) schizophrenia patients were discharged from short-stay (< or = 90 days) inpatient units in the United States during 1986. The estimated aggregate baseline inpatient cost for the index hospitalizations of this cohort was $2.3 billion (1993 dollars). Within 2 years after discharge, the aggregate cost of readmission approached $2 billion. Loss of neuroleptic efficacy accounted for roughly 60 percent of the rehospitalization costs and neuroleptic noncompliance for roughly 40 percent. The economic burden due to loss of efficacy is relatively higher during the first postdischarge year, whereas the burden from noncompliance is higher in the second year. Because loss of medication efficacy and medication noncompliance act synergistically on relapse, substantial inpatient cost savings can be realized by linking better pharmacologic treatments of schizophrenia with more effective strategies to manage medication noncompliance.

Attitudes towards long-acting depot antipsychotics: A survey of patients, relatives and psychiatrists

“…Non-adherence is one of the main factors undermining successful pharmacological relapse prevention. The costs of non-adherence are significant, with an estimated 40% of the total costs of the illness being attributed to rehospitalisations (Weiden and Olfson, 1995). There are several reasons for non-adherence in patients suffering from schizophrenia as side effects, limited insight to the disease and a negative attitude to medication (Buckley et al, 2007).…”

Strategies for Coping in a Complex World: Adherence Behavior Among Older Adults with Chronic Illness

“…1,2 Harm caused by nonadherence to appropriately prescribed medicines is significant. [3][4][5][6][7] Cost of illness in the US caused by nonadherence is estimated at $100 billion per annum, 8 referred to as the nation's "other drug problem." 9 Medication adherence increases with higher income and reduced medication costs, is variably related to age, gender, marital status, ethnicity, education, social support and presence of depression or cognitive impairment, number of prescribing physicians, and use of multiple pharmacies.…”

Relato do uso de clozapina em 56 pacientes atendidos pelo Programa de Atenção à Esquizofrenia Refratária da Secretaria da Saúde e do Meio Ambiente do Estado do Rio Grande do Sul

“…Além disso, é eficaz em uma proporção subs-Relato do uso de Clozapina -Gama et alii tancial (30 a 60%) de pacientes esquizofrêni-cos que não respondem ou não toleram a terapia com drogas antipsicóticas clássicas. Outros estudos mostram que pacientes com esquizofrenia refratária tratados com clozapina por períodos prolongados (seis meses a dois anos) [33][34][35] obtiveram melhora na adaptação social, integração e funções cognitivas [36][37][38][39] , remissão substancial da doença e conseqüentemente maior afastamento das internações hospitalares, melhor qualidade de vida e potencial de trabalho 37,[40][41][42][43][44][45] .…”

“…O tratamento do paciente esquizofrênico tem-se modificado nos últimos tempos, podendo-se citar: (a) desinstitucionalização; (b) melhora de tratamento na comunidade; (c) busca de otimização e racionalização de custos e recursos em saúde; (d) desenvolvimento de rotinas e padronização de recursos diagnósticos multiaxiais e de procedimentos; (e) montagem de programas de reabilitação, educação da família e do paciente sobre a doença e as formas de manejá-la 45 . Considerando o número de internações por paciente antes do uso da clozapina (6,8) ram uma melhora significativa da sintomatologia avaliada pelo BPRS após seis meses de início do tratamento e que esta melhora se mantém após noventa e três meses de início do tratamento com clozapina.…”