In a study published in Journal of Medical Economics, researchers evaluated the economic burden to commercial payers of managing schizophrenia in young adults in Colorado. When compared to a matched cohort of young adults without schizophrenia, researchers found that patients with schizophrenia incurred higher costs and used more healthcare resources, both before and after their diagnosis.
Given the burden to commercial payers, authors Jacqueline Pesa, PhD, and colleagues, identified a “need for intervention with evidence-based care for this vulnerable, challenging, and costly patient population.”
Primary outcomes measured were direct costs and health resource utilization (HRU). The Colorado All-Payer Claims Database, covering approximately 76% of the insured Colorado population, was searched for commercial insurance holders aged 18 to 34 years both with and without schizophrenia to be included in the study. A schizophrenia cohort and a propensity score–matched non-schizophrenia cohort were formed. All-cause (total), mental health (MH)–related, and non-MH–related per patient per month (PPPM) costs were calculated, along with HRU per 100 patients per month (PHPPM). The values were compared between the two groups before and after the initial index date, up to 48 months.
The study cohort was comprised of 501 patients with schizophrenia and the control cohort was comprised of 2,510 patients without schizophrenia. HRU and costs were higher for schizophrenia patients both pre- and post-index date compared to the control group.
Prior to indexing in the schizophrenia cohort, there were 32.3 more office visits PHPPM, 2.1 more admissions PHPPM, and 104.8 more prescriptions PHPPM, relative to the non-schizophrenia cohort (all p < 0.01). The investigators found that the most of the higher number of office visits and prescriptions in the schizophrenia cohort were related to MH.
After the index date, the schizophrenia cohort had 89.6 more office visits PHPPM, 7.2 more admissions PHPPM, and 181.6 more prescriptions PHPPM compared to the control group (all p < 0.001).
All-cause costs in the pre-index period were $457 ($373 attributed to MH) higher PPPM for the schizophrenia cohort (p < 0.001). Post-index, all-cause costs for the schizophrenia cohort were $1,687 ($1,258 attributed to MH) higher PPPM (all p < 0.001). Approximately 40% of patients with schizophrenia remained on commercial insurance after four years compared with approximately 75% in the non-schizophrenia cohort.
The researchers recognized that, as findings from this study were based on data from a single state, they may not be applicable for other states. Further, the use of schizophrenia diagnosis as the index date when analyzing costs and HRU may not capture the intricacies of initial disease identification.
Regardless, the authors surmise that young adults with schizophrenia are significantly more burdensome to commercial payers than matched patients without schizophrenia because of increased HRU and costs from both MH-related and non-MH–related services.
Source: Journal of Medical Economics
