Does Non-Adherence Increase Treatment Costs in Schizophrenia?

Pennington, Mark; McCrone, Paul

doi:10.1007/s40273-018-0652-3

Cited by 11 publications

(11 citation statements)

References 58 publications

(160 reference statements)

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“…Although an increase in hospitalization costs is typically observed with AP non-adherence, this increase is often offset by decreased pharmacy costs. 12 The current study found that non-adherent patients with uncontrolled symptoms of schizophrenia incurred $20,787 higher mean healthcare costs annually compared to patients without schizophrenia. This cost difference appears to be higher than the cost difference between all patients with and without schizophrenia ($14,087).…”

Section: Baseline Characteristicsmentioning

confidence: 58%

“…patients with schizophrenia who are not adherent to AP therapy are commonly reported. 12,20 Of note, patients older than 65 years comprised a lower share (12%) of non-adherent patients with uncontrolled symptoms of schizophrenia, which may explain the lower contribution of LTC visits to the mean total healthcare cost difference.…”

Section: Discussionmentioning

confidence: 99%

“…11 The cost effect of non-adherence, however, is less clearly established, as a decrease in pharmacy costs among non-adherent patients may potentially offset an increase in hospitalization costs. 12 The economic burden incurred by specific sub-populations of patients with schizophrenia, such as those with a recent relapse or those who are not adherent to AP therapy with uncontrolled symptoms, has not yet been characterized. Given that it may differ from the economic burden incurred by all schizophrenia patients on average, the objective of the present study was to quantify it using the Medicaid data from six states.…”

Section: What This Study Addsmentioning

confidence: 99%

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Economic burden in Medicaid beneficiaries with recently relapsed schizophrenia or with uncontrolled symptoms of schizophrenia not adherent to antipsychotics

Pilon

Patel

Lafeuille

et al. 2021

JMCP

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BACKGROUND:Patients with schizophrenia struggle with disease relapses and uncontrolled symptoms, which can either result in or be a result of non-adherence to antipsychotics (APs). The economic burden of such patients is hypothesized to be substantial. OBJECTIVE:To evaluate the economic burden of recently relapsed schizophrenia or of uncontrolled symptoms of schizophrenia with non-adherence to APs in Medicaid beneficiaries. METHODS:Adults with ≥ 2 schizophrenia diagnoses and controls without schizophrenia were identified in Medicaid data (1997Q1-2018Q1) from Iowa, Kansas, Mississippi, Missouri, New Jersey, and Wisconsin. The index date was the last observed schizophrenia diagnosis (cohort with schizophrenia) or the last service claim (control cohort) with ≥ 12 months of continuous Medicaid enrollment before and after it. Cohorts were matched 1:1 using propensity scores. After matching, two subgroups were identified among adults with schizophrenia: (1) patients with schizophrenia and a recent relapse (≥ 1 schizophrenia-related inpatient or emergency department claim ≤ 60 days before or on the index date) and(2) patients with uncontrolled symptoms of schizophrenia (≥ 2 schizophrenia-related hospitalizations) and non-adherence to APs (proportion of days covered < 80%) in the 12-month pre-index period. Previously matched controls were then subset to patients in each subgroup and their matched pairs without schizophrenia, thus maintaining the 1:1 matching ratio. Healthcare resource utilization (HRU) and costs ($2018 USD) in the 12-month post-index (observation) period were compared between matched pairs using adjusted regression models.

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Section: Baseline Characteristicsmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: What This Study Addsmentioning

confidence: 99%

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Economic burden in Medicaid beneficiaries with recently relapsed schizophrenia or with uncontrolled symptoms of schizophrenia not adherent to antipsychotics

Pilon

Patel

Lafeuille

et al. 2021

JMCP

View full text Add to dashboard Cite

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“…However, associations between adherence and costs should be interpreted with caution because prior studies have reported adherence is associated with higher pharmacy costs but not overall cost savings 29 . Although findings in the literature are mixed, the current study has found evidence of decreased total medical and total costs in spite of an increase in pharmacy costs.…”

Section: Discussionmentioning

confidence: 98%

Transitioning from oral risperidone or paliperidone to once-monthly paliperidone palmitate: a real-world analysis among Veterans Health Administration patients with schizophrenia who have had at least one prior hospitalization

Khoury

Patel

Huang

et al. 2019

Current Medical Research and Opinion

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Objective: To address gaps in the literature on healthcare resource utilization (HRU) and costs among patients with schizophrenia and prior hospitalization who transition from oral risperidone or paliperidone (oral ris/pali) to once-monthly paliperidone palmitate (PP1M) in a real-world setting by comparing treatment patterns, HRU, and costs 12-months pre-and post-transition to PP1M among Veterans Health Administration (VHA) patients affected by schizophrenia who have had !1 hospitalization. Methods: VHA patients with schizophrenia (aged !18 years) who initiated oral ris/pali, had !1 allcause inpatient stay, and transitioned to PP1M from January 2015-March 2017 were included from the VHA database. The first transition date to PP1M was identified as the index date. Patients were required to have continuous health plan eligibility for 12 months pre-and post-PP1M. Outcomes were compared using the Wilcoxon signed-rank and McNemar's test, as appropriate. Results: The study included 319 patients (mean [SD] age ¼ 51.6 [4.2] years) during 12 months of baseline and follow-up. During pre-PP1M transition, 7.2% of the patients were adherent (proportion of days covered [PDC] ! 80%) to oral ris/pali. Post-PP1M transition, 27.6% of the patients were adherent to PP1M. Comparison of HRU outcomes from the pre-to post-PP1M transition revealed significantly lower all-cause inpatient stays (3.5 vs 1.4, p < .0001) and shorter inpatient length of stay (43.4 vs 18.3 days, p < .0001). Similar trends were seen for mental health and schizophrenia-related HRU. Cost outcome comparison indicated significantly lower all-cause inpatient costs

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“…Research on registry data is rare. Most of the available studies analyze one aspect of healthcare for patients with schizophrenia, for instance the use of antipsychotic medication, costs, family services, or continuity of care[5,8,10,23–25,50–54]. Our examination of the relationship between continuity of care, co-payments and episodic psychiatric care, with acute psychiatric care as a proxy of quality of care, is new and encompasses all types of care available.…”

Section: Conclusion and Discussionmentioning

confidence: 99%

Rising co-payments coincide with unwanted effects on continuity of healthcare for patients with schizophrenia in the Netherlands

2019

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BackgroundCo-payments, used to control rising costs of healthcare, may lead to disruption of appropriate outpatient care and to increases in acute crisis treatment or hospital admission in patients with schizophrenia. An abrupt rise in co-payments in 2012 in the Netherlands offered a natural experiment to study the effects of co-payments on continuity of healthcare in schizophrenia.MethodsRetrospective longitudinal registry-based cohort study. Outcome measures were (i) continuity of elective (planned) psychiatric care (outpatient care and/or antipsychotic medication); (ii) acute psychiatric care (crisis treatment and hospital admission); and (iii) somatic care per quarter of the years 2009–2014.Results10 911 patients with schizophrenia were included. During the six-year follow-up period the level of elective psychiatric outpatient care (-20%); and acute psychiatric care (-37%) decreased. Treatment restricted to antipsychotic medication (without concurrent outpatient psychiatric care) increased (67%). The use of somatic care also increased (24%). Use of acute psychiatric care was highest in quarters when only antipsychotic medication was received. The majority (59%) of patients received continuous elective psychiatric care in 2009–2014. Patients receiving continuous care needed only half the acute psychiatric care needed by patients not in continuous care. On top of these trends time series analysis (ARIMA) showed that the abrupt rise in co-payments from 2012 onwards coincided with significant increases in stand-alone treatment with antipsychotic medication and acute psychiatric care.ConclusionsThe use of psychiatric care decreased substantially among a cohort of patients with schizophrenia. The high rise in co-payments from 2012 onwards coincided with significant increases in stand-alone treatment with antipsychotic medication and acute psychiatric care.

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Does Non-Adherence Increase Treatment Costs in Schizophrenia?

Abstract: Inference from analysis of administrative data is limited by the risk of selection bias. Inference from trials is limited by small sample sizes. The literature does not consistently support an assumption that non-adherence increases healthcare costs.

Cited by 11 publications

References 58 publications

Economic burden in Medicaid beneficiaries with recently relapsed schizophrenia or with uncontrolled symptoms of schizophrenia not adherent to antipsychotics

Economic burden in Medicaid beneficiaries with recently relapsed schizophrenia or with uncontrolled symptoms of schizophrenia not adherent to antipsychotics

Transitioning from oral risperidone or paliperidone to once-monthly paliperidone palmitate: a real-world analysis among Veterans Health Administration patients with schizophrenia who have had at least one prior hospitalization

Rising co-payments coincide with unwanted effects on continuity of healthcare for patients with schizophrenia in the Netherlands

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