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In the Schizophrenia Outpatient Health Outcomes (SOHO) study, a 3-year, prospective, observational study of 10, 972 outpatients with schizophrenia across 10 European countries, costs associated with relapse were analyzed. Data regarding inpatient days, day care center days, outpatient consultations, antipsychotic drugs, and concomitant medications were collected during routine clinician visits, and costs were estimated from several United Kingdom-based price indexes. Relapse was defined as a 3-point increase in the Clinical Global Impression (CGI) overall severity score or having a hospitalization.[Hong et al., 2009]
The US Schizophrenia Care and Assessment Program (US-SCAP) study, a prospective, observational, noninterventional study of schizophrenia in the United States conducted between 1997 and 2003, included community mental health centers, university health care systems, community and state hospitals, and the Department of Veterans Affairs (VA) Health Services. Total direct mental health costs and cost components of patients with and without relapse in the prior 6 months were compared over the following year by using the propensity score matching method. Relapse was defined as having any of the following: psychiatric hospitalization, use of emergency services, use of a crisis bed, or a suicide attempt. Total 1-year direct mental health costs included these cost components: costs of medications (antipsychotics and other psychotropics, such as mood stabilizers, anticholinergics, antidepressants, and anti-anxiety and sleep agents), psychiatric hospitalizations, day treatment, emergency services, psychosocial group therapy, medication management, individual therapy, and Assertive Community Treatment (ACT) case management. Costs of atypical antipsychotic medications were based on average wholesale prices discounted by 15%; costs of psychiatric hospitalization were based on per diem costs at each site; costs of mental health services, other than psychiatric hospitalizations, were based on their relative value units developed from resource utilization and cost data available from the management information systems at each site.[Ascher-Svanum et al., 2010]
A series of multivariate regressions were performed with statewide 2001–2003 California Medicaid (Medi-Cal) data to estimate the fraction of acute-care hospital admissions and hospital days for schizophrenia that were attributable to gaps in antipsychotic medication treatment. This fraction was then applied to national estimates of the number and costs of inpatient treatment episodes for patients with schizophrenia in the national Medicaid program. This analysis focused on prescriptions of oral antipsychotic medications (patients receiving long-acting medications were excluded). Medi-Cal recipients aged 18 to 64 years who had received at least 2 outpatient or 1 inpatient claim for schizophrenia were selected. Two federal surveys were used to estimate the total national distribution and costs of Medicaid-reimbursed acute care for hospital admissions for schizophrenia: (1) the 1997 Client/Patient Sample Survey (CPSS); (2) the 2002 Survey of Mental Health Organizations (SMHO), General Hospital Mental Health Services, and Managed Behavioral Health Organizations. According to the 1997 CPSS, there are an estimated 86, 878 annual acute care hospital admissions and a total of 930, 062 inpatient days provided to Medicaid-financed patients for the treatment of schizophrenia in the United States. The total cost of these inpatient admissions is approximately $806 million. This estimate is derived by applying the 2002 SMHO mean daily costs of inpatient treatment for each organization, adjusted for inflation, to the estimated number of inpatient days in that organization. Applying the adjusted attributable fraction of inpatient admissions due to gaps in antipsychotic treatment (12.3%) to the national estimate of admissions yields 10, 686 annual acute care hospital admissions attributable to gaps in antipsychotic treatment. Applying the adjusted attributable fraction of inpatient days (13.1%) yields 121, 838 inpatient days and an inpatient cost of approximately $106 million attributed to gaps in treatment.[Marcus et al., 2008]
References:
Hong J, Windmeijer F, Novick D, Haro JM, Brown J. The cost of relapse in patients with schizophrenia in the European SOHO (Schizophrenia Outpatient Health Outcomes) study. Prog Neuropsychopharmacol Biol Psychiatry. 2009; 33(5): 835-841.
Ascher-Svanum H, Zhu B, Faries DE, et al. The cost of relapse and the predictors of relapse in the treatment of schizophrenia. BMC Psychiatry. 2010; 10:2.
Marcus SC, Olfson M. Outpatient antipsychotic treatment and inpatient costs of schizophrenia. Schizophr Bull. 2008; 34(1): 173-180.