Health Care Resource Use, Costs, and Diagnosis Patterns in Patients With Schizophrenia and Bipolar Disorder: Real-world Evidence From US Claims Databases

Broder, Michael S.; Greene, Mallik; Chang, Eunice; Hartry, Ann; Touya, Maëlys; Munday, Jennifer; Yan, Tingjian

doi:10.1016/j.clinthera.2018.08.004

Cited by 14 publications

(13 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Additionally, annual all-cause direct medical payments associated with TRD ($9,890) are similar to patients with anxiety disorder but are less than financial payments among patients with either schizophrenia or bipolar 1 disorder. [26][27][28][29][30][31][32][33][34] Similar to other recently published, retrospective claimsbased analyses, our findings suggest a significant economic burden associated with TRD. [8][9][10][11][12][15][16][17][18][19][20] Compared with existing literature, our findings for annual all-cause health care payments associated with TRD ($3,042) appear to be more conservative.…”

Section: ■■ Conclusionsupporting

confidence: 85%

Economic Burden of Treatment-Resistant Depression on the U.S. Health Care System

Sussman¹,

O’Sullivan

Shah

et al. 2019

JMCP

View full text Add to dashboard Cite

BACKGROUND: Treatment-resistant depression (TRD), defined as episodes of depression that do not respond to ≥ 2 lines of adequate depression therapy, is associated with a high economic burden. Although the economic burden of TRD is reported elsewhere, its exact magnitude and current value is uncertain due to differences in methodology in TRD identification.OBJECTIVE: To compare all-cause health care resource utilization (HCRU) and associated health care payments among patients with TRD and those with depression but without TRD, using administrative claims data.METHODS: This retrospective cohort study used data from the Truven Health MarketScan Commercial and Medicare Supplemental Databases (October 1, 2008-September 30, 2016. All patients were aged ≥ 18 years, newly diagnosed with depression (≥ 1 inpatient admission or ≥ 2 outpatient visits with a primary or secondary depression diagnosis), and newly treated with depression therapy. The population included patients with and without TRD. Patients with TRD were defined as having been treated with ≥ 3 courses of depression therapy within a 360-day period (initiation of the third course served as the TRD index date), while patients without TRD (non-TRD) were defined as having been treated with 2 courses of depression therapy. TRD and non-TRD cohorts were matched using propensity scores. Using the TRD index date of their matched TRD pair, non-TRD patients were assigned a simulated index date following second-line therapy. Eligible TRD and non-TRD patients were continuously enrolled from a 12-month baseline period before the first course of therapy through a 12-month follow-up period beginning with the TRD index date and simulated index date, respectively. Annual all-cause HCRU and associated payments (2016 U.S. dollars) were assessed in aggregate and by place of service during the follow-up period and were compared between the matched cohorts using nonparametric Wilcoxon signed-rank tests. RESULTS:The matched analysis included 800 patients in each cohort. For both cohorts, the mean age of patients was 39 years, and 60% were female. All clinical characteristics and all-cause HCRU were comparable at baseline. Compared with non-TRD patients, TRD patients had a significantly higher mean number of all-cause emergency department (ED) visits (0.29 vs. 0.24), outpatient visits (18.0 vs. 13.4), and prescriptions (30.0 vs. 24.0; all P < 0.05) during the 12-month follow-up period. The TRD cohort also had significantly higher mean total all-cause health care payments

show abstract

Section: ■■ Conclusionsupporting

confidence: 85%

Economic Burden of Treatment-Resistant Depression on the U.S. Health Care System

Sussman¹,

O’Sullivan

Shah

et al. 2019

JMCP

View full text Add to dashboard Cite

show abstract

“…Associations between concurrently diagnosed bipolar disorder and schizophrenia and either antipsychotic medication adherence or diabetes testing also appear understudied. This gap could arise from the view that mood disorders and schizophrenia spectrum disorders are non-concurrent conditions [58]. Although patients may simultaneously experience symptoms of both schizophrenia and mood disorder (e.g., mania, depressed mood), diagnostic coding and clinical practices dictate that these persons receive a schizophrenia spectrum disorder diagnosis (specifically, schizoaffective disorder) Table 1 Characteristics of Medicaid specialty plan enrollees with schizophrenia or bipolar disorders who are on antipsychotic medications, examined in the context of two HEDIS measures, 2015.…”

Section: Clinical Characteristicsmentioning

confidence: 99%

“…The two measures of interest were 1) adherence to antipsychotic medication (SAA), which includes persons with schizophrenia, and 2) receipt of recommended diabetes screening (SSD), which includes persons with schizophrenia or bipolar disorder. Significance was tested using unadjusted random effect logistic regression models (Continued) rather than separate mood and schizophrenia diagnoses [58,59]. In practice both types of diagnoses may appear concurrently in real-world administrative data due to multiple diagnosing providers or variations and imperfections in coding practices [58,60].…”

Section: Clinical Characteristicsmentioning

confidence: 99%

“…Significance was tested using unadjusted random effect logistic regression models (Continued) rather than separate mood and schizophrenia diagnoses [58,59]. In practice both types of diagnoses may appear concurrently in real-world administrative data due to multiple diagnosing providers or variations and imperfections in coding practices [58,60]. Although many studies stringently categorize patients into mutually exclusive diagnostic groups (i.e., all patients with a schizophrenia spectrum diagnosis are categorized as having schizophrenia and only those without a schizophrenia diagnosis are categorized as having a mood disorder) [19,[61][62][63], such methods mask clinical complexity for patients whose real-world data include both types of conditions.…”

Section: Clinical Characteristicsmentioning

confidence: 99%

See 1 more Smart Citation

Antipsychotic medication adherence and preventive diabetes screening in Medicaid enrollees with serious mental illness: an analysis of real-world administrative data

Stockbridge

Dhakal

Garg

et al. 2021

BMC Health Serv Res

View full text Add to dashboard Cite

Background There is excess amenable mortality risk and evidence of healthcare quality deficits for persons with serious mental illness (SMI). We sought to identify sociodemographic and clinical characteristics associated with variations in two 2015 Healthcare Effectiveness Data and Information Set (HEDIS) measures, antipsychotic medication adherence and preventive diabetes screening, among Medicaid enrollees with serious mental illness (SMI). Methods We retrospectively analyzed claims data from September 2014 to December 2015 from enrollees in a Medicaid specialty health plan in Florida. All plan enrollees had SMI; analyses included continuously enrolled adults with antipsychotic medication prescriptions and schizophrenia or bipolar disorder. Associations were identified using mixed effects logistic regression models. Results Data for 5502 enrollees were analyzed. Substance use disorders, depression, and having both schizophrenia and bipolar disorder diagnoses were associated with both HEDIS measures but the direction of the associations differed; each was significantly associated with antipsychotic medication non-adherence (a marker of suboptimal care quality) but an increased likelihood of diabetes screening (a marker of quality care). Compared to whites, blacks and Hispanics had a significantly greater risk of medication non-adherence. Increasing age was significantly associated with increasing medication adherence, but the association between age and diabetes screening varied by sex. Other characteristics significantly associated with quality variations according to one or both measures were education (associated with antipsychotic medication adherence), urbanization (relative to urban locales, residing in suburban areas was associated with both adherence and diabetes screening), obesity (associated with both adherence and diabetes screening), language (non-English speakers had a greater likelihood of diabetes screening), and anxiety, asthma, and hypertension (each positively associated with diabetes screening). Conclusions The characteristics associated with variations in the quality of care provided to Medicaid enrollees with SMI as gauged by two HEDIS measures often differed, and at times associations were directionally opposite. The variations in the quality of healthcare received by persons with SMI that were identified in this study can guide quality improvement and delivery system reform efforts; however, given the sociodemographic and clinical characteristics’ differing associations with different measures of care quality, multidimensional approaches are warranted.

show abstract

“…Severe mental illnesses (SMIs), including schizophrenia (SZ), bipolar disorder (BD) and major depressive disorder (MDD), affect approximately one in five persons [ 1 ] and are a major cause of long-term disability worldwide [ 2 ]. SMIs lead to significant impairments in the general functioning and well-being of an individual [ 3 ] and are associated with a higher use of health care resources [ 3 , 4 ], excess costs [ 3–6 ] and significant premature mortality [ 7 , 8 ]. Individuals with SMIs face greater difficulties in accessing and receiving health services and are less likely to receive standard level care [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

A conceptual framework to develop a patient-reported experience measure of the quality of mental health care: a qualitative study of the PREMIUM project in France

Fernandes

Fond

Zendjidjian

et al. 2021

Journal of Market Access & Health Policy

View full text Add to dashboard Cite

Background : The objective of this study was to develop a conceptual framework to define a domain map describing the experience of patients with severe mental illnesses (SMIs) on the quality of mental health care. Methods : This study used an exploratory qualitative approach to examine the subjective experience of adult patients (18–65 years old) with SMIs, including schizophrenia (SZ), bipolar disorder (BD) and major depressive disorder (MDD). Participants were selected using a purposeful sampling method. Semistructured interviews were conducted with 37 psychiatric inpatients and outpatients recruited from the largest public hospital in southeastern France. Transcripts were subjected to an inductive analysis by using two complementary approaches (thematic analysis and computerized text analysis) to identify themes and subthemes. Results : Our analysis generated a conceptual model composed of 7 main themes, ranked from most important to least important as follows: interpersonal relationships, care environment, drug therapy, access and care coordination, respect and dignity, information and psychological care. The interpersonal relationships theme was divided into 3 subthemes: patient-staff relationships, relations with other patients and involvement of family and friends. All themes were spontaneously raised by respondents. Conclusion : This work provides a conceptual framework that will inform the subsequent development of a patient-reported experience measure to monitor and improve the performance of the mental health care system in France. The findings showed that patients with SMIs place an emphasis on the interpersonal component, which is one of the important predictors of therapeutic alliance. Trial registration : NCT02491866

show abstract

Health Care Resource Use, Costs, and Diagnosis Patterns in Patients With Schizophrenia and Bipolar Disorder: Real-world Evidence From US Claims Databases

Cited by 14 publications

References 30 publications

Economic Burden of Treatment-Resistant Depression on the U.S. Health Care System

Economic Burden of Treatment-Resistant Depression on the U.S. Health Care System

Antipsychotic medication adherence and preventive diabetes screening in Medicaid enrollees with serious mental illness: an analysis of real-world administrative data

A conceptual framework to develop a patient-reported experience measure of the quality of mental health care: a qualitative study of the PREMIUM project in France

Contact Info

Product

Resources

About