Health care resource utilization and direct medical costs for patients with schizophrenia initiating treatment with atypical versus typical antipsychotics in Tianjin, China

Abstract

BackgroundIt is uncertain whether the extra acquisition costs of atypical antipsychotics over typical antipsychotics are offset by their other reduced resource use especially in hospital services in China. This study compared the psychiatric-related health care resource utilization and direct medical costs for patients with schizophrenia initiating atypical or typical antipsychotics in Tianjin, China.MethodsData were obtained from the Tianjin Urban Employee Basic Medical Insurance database (2008–2010). Adult patients with schizophrenia with ≥1 prescription for antipsychotics after ≥90-day washout and 12-month continuous enrollment after first prescription was included. Psychiatric-related resource utilization and direct medical costs of the atypical and typical cohorts were estimated during the 12-month follow-up period. Logistic regressions, ordinary least square (OLS), and generalized linear models (GLM) were employed to estimate differences of resource utilization and costs between the two cohorts. One-to-one propensity score matching was conducted as a sensitivity analysis.Results1131 patients initiating either atypical (N = 648) or typical antipsychotics (N = 483) were identified. Compared with the typical cohort, the atypical cohort had a lower likelihood of hospitalization (45.8% vs. 56.7%, P < 0.001; adjusted OR: 0.58, P < 0.001) over the follow-up period. Medication costs for the atypical cohort were higher than the typical cohort ($438 vs. $187, P < 0.001); however, their non-medication medical costs were significantly lower ($1223 vs. $1704, P < 0.001). The total direct medical costs were similar between the atypical and typical cohorts before ($1661 vs. $1892, P = 0.100) and after matching ($1711 vs. 1868, P = 0.341), consistent with the results from OLS and GLM models for matched cohorts.ConclusionsThe atypical cohort had similar total direct medical costs compared to the typical cohort. Higher medication costs associated with atypical antipsychotics were offset by a reduction in non-medication medical costs, driven by fewer hospitalizations.

Drug utilization pattern in Schizophrenia

“…But with the advent of the second generation antipsychotics which are more efficacious and with better tolerability, they have become the first line drugs for the treatment of schizophrenia. 4,5 However the cost of second generation antipsychotics have been 10 times more than those of first generation antipsychotics. 6 These cost differences is the main contributor to relatively low prescription rates of second generation antipsychotics in developing countries.…”

Socioeconomic inequality in rehabilitation service utilization for schizophrenia in China: Findings from a 7-year nationwide longitudinal study

“…Most patients with schizophrenia experience chronic debilitating symptoms with frequent relapses during the progression of the disease and require long-term medical treatment and care services (6). Antipsychotic medications are currently the most effective treatment for the amelioration of symptoms and the management of acute psychotic exacerbations, and adherence is crucial to prevent relapse (7). In the meantime, patients with first-episode schizophrenia have been found to benefit from psychological therapy, such as cognitive-behavioral therapy, which was demonstrated by studies from both China (8) and developed countries (9) to be an effective treatment to reduce symptoms and enhance insight and social functioning that is not amenable to medication.…”