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Antipsychotic adherence patterns and health care utilization and costs among patients discharged after a schizophrenia-related hospitalization

Background: This study aimed to assess antipsychotic adherence patterns and all-cause and schizophrenia-related health care utilization and costs sequentially during critical clinical periods (i. e., before and after schizophreniarelated hospitalization) among Medicaid-enrolled patients experiencing a schizophrenia-related hospitalization. Methods: All patients aged >= 18 years with a schizophrenia-related inpatient admission were identified from the MarketScan Medicaid database (2004-2008). Adherence (proportion of days covered [PDC]) to antipsychotics and schizophrenia-related and all-cause health care utilization and costs were assessed during preadmission (182- to 121-day, 120- to 61-day, and 60-to 0-day periods; overall, 6 months) and postdischarge periods (0- to 60-day, 61- to 120-day, 121- to 180-day, 181- to 240-day, 241- to 300-day, and 301- to 365-day periods; overall, 12 months). Health care utilization and costs (2010 US dollars) were compared between each adjacent 60-day follow-up period after discharge using univariate and multivariable regression analyses. No adjustment was made for multiplicity. Results: Of the 2,541 patients with schizophrenia (mean age: 41.2 years; 57% male; 59% black) who were identified, approximately 89% were ' discharged to home self-care.'Compared with the 60-to 0-day period before the index inpatient admission, greater mean adherence as measured by PDC was observed during the 0-to 60-day period immediately following discharge (0.46 vs. 0.78, respectively). The mean PDC during the overall 6-month preadmission period was lower than during the 6-month postdischarge period (0.53 vs. 0.69; P < 0.001). Compared with the 0-to 60-day postdischarge period, schizophrenia-related health care costs were significantly lower during the 61- to 120-day postdischarge period (mean: $ 2,708 vs. $ 2,102; P < 0.001); the primary cost drivers were rehospitalization (mean: $ 978 vs. $ 660; P < 0.001) and pharmacy (mean: $ 959 vs. $ 743; P < 0.001). Following the initial 60-day period, both all-cause and schizophrenia-related costs declined and remained stable for the remaining postdischarge periods (days 121-365). Conclusions: Although long-term (e.g., 365-day) adherence measures are important, estimating adherence over shorter intervals may clarify the course of vulnerability to risk and enable clinicians to better design adherence/riskrelated interventions. The greatest risk of rehospitalization and thus greater resource utilization were observed during the initial 60-day postdischarge period. Physicians should consider tailoring management and treatment strategies to help mitigate the economic and humanistic burden for patients with schizophrenia during this period


Markowitz, M., Karve, S., Panish, J., Candrilli, S., & Alphs, L. (2013). Antipsychotic adherence patterns and health care utilization and costs among patients discharged after a schizophrenia-related hospitalization. BMC Psychiatry, 13, [246]. DOI: 10.1186/1471-244X-13-246

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