The use of conventional antipsychotic medications for patients with schizophrenia in a medicaid population: therapeutic and cost outcomes over 2 years.
OBJECTIVE
To evaluate the association between drug therapy patterns achieved with conventional antipsychotics and direct healthcare costs over 2 years.


METHODS
Paid claims data from the California Medicaid (Medi-Cal) program were used to identify 2476 patients with schizophrenia for whom 2 years of data were available. Ordinary least squares (OLS) regression models were used to estimate the association between lack of antipsychotic drug therapy, delayed therapy, changes in medications, and continuous therapy on healthcare costs over a 2-year period.


RESULTS
Nearly 99% of Medi-Cal patients with schizophrenia were treated with conventional antipsychotics. Patients with schizophrenia consumed nearly $48,000 in direct costs over 2 years. Over 16% of patients did not use any antipsychotic medication for 2 years. Untreated patients used more healthcare resources than treated patients did ($10,833, P = .0422), especially psychiatric hospital care ($8,027, P = .0004). However, treated patients frequently experienced suboptimal drug use patterns. Nearly 33% of treated patients delayed antipsychotic therapy for up to 2 years. Delayed therapy was associated with increased costs of $12,285 (P = .070). Over 56% of patients experienced changes in therapy that were associated with higher total direct costs ($17,644, P < .0001). Finally, only 3.2% of treated patients used an antipsychotic medication consistently for 2 years. However, continuous drug therapy was not associated with lower costs.


CONCLUSIONS
Suboptimal drug use patterns are common and costly in Medi-Cal patients with schizophrenia who initiated therapy with conventional antipsychotics.
McCombs
J S
JS
Department of Pharmaceutical Economics and Policy, School of Pharmacy, University of Southern California, Los Angeles, CA, USA. jmccombs@hsc.usc.edu
Luo
M
M
Johnstone
B M
BM
Shi
L
L
D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000191:economics* / Q000627:therapeutic use*; D002140:California; D003362:Cost-Benefit Analysis; D017723:Drug Utilization Review; D005260:Female; D005569:Formularies as Topic; D017048:Health Care Costs / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D008297:Male; D008484:Medicaid / Q000191:economics / Q000706:statistics & numerical data; D008875:Middle Aged; D010349:Patient Compliance; D012044:Regression Analysis; D012559:Schizophrenia / Q000188:drug therapy* / Q000191:economics*
D014150:Antipsychotic Agents