QUALITY-CONSTANT "PRICES" FOR THE ONGOING TREATMENT OF SCHIZOPHRENIA: AN EXPLORATORY STUDY*
Health care expenditures have been increasing sharply in the last ten years, with spending on mental health disorders being particularly prominent. Over the same time period, a number of new antipsychotic medications have been added to the armamentarium for treatment of persons diagnosed with schizophrenia. Due in part to the sharply increased expenditures by Medicaid on mental health disorders such as schizophrenia, controversies have arisen as to the use of these more costly innovative medications, particularly their impact on the annualized cost of treating patients.Using Medicaid data on 12,864 person years from two counties in Florida over the 1994-95 to 1999-2000 time period, in this study we address three issues: (i) On a per person year basis, what is happening over time to the mental health-related costs of treating schizophrenia? (ii) How is the composition and quality of care changing over time? and (iii) Holding quality of care constant, on a per person year basis, by how much are the costs for the ongoing treatment of schizophrenia changing?We find that unadjusted for changes in quality of care over time, the annualized costs for the ongoing treatment of schizophrenia per person have increased about 0.5% per year. The composition of treatments for schizophrenia has changed substantially over this six-year time period, toward more intensive use of atypical antipsychotics, and away from psychosocial treatments. Holding treatment quality type and patient characteristics constant over time, mean treatment costs have fallen about 5.5% per year between 1994-1995 and 1999-2000.
Frank
Richard G
RG
Harvard Medical School, Boston, MA USA and National Bureau of Economic Research, Cambridge, MA USA.
Berndt
Ernst R
ER
Busch
Alisa B
AB
Lehman
Anthony F
AF
Health Aff (Millwood). 1999 Sep-Oct;18(5):71-88
10495594
Psychiatr Clin North Am. 1993 Jun;16(2):413-23
8332569
Am J Psychiatry. 2000 Jul;157(7):1089-94
10873916
Schizophr Bull. 1998;24(1):1-10
9502542
Health Aff (Millwood). 1995 Fall;14(3):50-64
7498903
J Clin Psychiatry. 2000 Jan;61(1):16-21
10695640
Arch Gen Psychiatry. 1999 Jun;56(6):565-72
10359474
N Engl J Med. 1997 Sep 18;337(12):809-15
9295240
Arch Gen Psychiatry. 2004 May;61(5):442-8
15123488
J Ment Health Policy Econ. 2002 Mar;5(1):3-19
12529566
Med Decis Making. 2002 May-Jun;22(3):245-61
12058782
Health Serv Res. 2002 Dec;37(6):1583-601
12546287
Br J Psychiatry Suppl. 1994 Apr;(23):29-38
8037899
Ment Health Serv Res. 2000 Jun;2(2):115-20
11256718
Hosp Community Psychiatry. 1992 Jan;43(1):69-71
1544654
Arch Gen Psychiatry. 1998 Jul;55(7):645-51
9672056
Health Aff (Millwood). 1999 Sep-Oct;18(5):52-65
10495592
Health Aff (Millwood). 2003 Sep-Oct;22(5):51-64
14515881
Schizophr Bull. 1998;24(1):11-20; discussion 20-32
9502543
J Health Econ. 2002 May;21(3):373-96
12022264
J Ment Health Policy Econ. 1998 Oct 1 ;1(3):109-117
11971150