Costs of treating patients with schizophrenia who have illness-related crisis events.
BACKGROUND
Relatively little is known about the relationship between psychosocial crises and treatment costs for persons with schizophrenia. This naturalistic prospective study assessed the association of recent crises with mental health treatment costs among persons receiving treatment for schizophrenia.


METHODS
Data were drawn from a large multi-site, non-interventional study of schizophrenia patients in the United States, conducted between 1997 and 2003. Participants were treated at mental health treatment systems, including the Department of Veterans Affairs (VA) hospitals, community mental health centers, community and state hospitals, and university health care service systems. Total costs over a 1-year period for mental health services and component costs (psychiatric hospitalizations, antipsychotic medications, other psychotropic medications, day treatment, emergency psychiatric services, psychosocial/rehabilitation group therapy, individual therapy, medication management, and case management) were calculated for 1557 patients with complete medical information. Direct mental health treatment costs for patients who had experienced 1 or more of 5 recent crisis events were compared to propensity-matched samples of persons who had not experienced a crisis event. The 5 non-mutually exclusive crisis event subgroups were: suicide attempt in the past 4 weeks (n = 18), psychiatric hospitalization in the past 6 months (n = 240), arrest in the past 6 months (n = 56), violent behaviors in the past 4 weeks (n = 62), and diagnosis of a co-occurring substance use disorder (n = 413).


RESULTS
Across all 5 categories of crisis events, patients who had a recent crisis had higher average annual mental health treatment costs than patients in propensity-score matched comparison samples. Average annual mental health treatment costs were significantly higher for persons who attempted suicide ($46,024), followed by persons with psychiatric hospitalization in the past 6 months ($37,329), persons with prior arrests ($31,081), and persons with violent behaviors ($18,778). Total cost was not significantly higher for those with co-occurring substance use disorder ($19,034).


CONCLUSIONS
Recent crises, particularly suicide attempts, psychiatric hospitalizations, and criminal arrests, are predictive of higher mental health treatment costs in schizophrenia patients.
Zhu
Baojin
B
Eli Lilly and Company, Indianapolis, USA. ZHU_BAOJIN@LILLY.COM
Ascher-Svanum
Haya
H
Faries
Douglas E
DE
Peng
Xiaomei
X
Salkever
David
D
Slade
Eric P
EP
D000328:Adult; D003365:Costs and Cost Analysis; D003710:Demography; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics; D006761:Hospitals; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000191:economics*; D011446:Prospective Studies; D011584:Psychology; D012559:Schizophrenia / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D013313:Stress Disorders, Post-Traumatic / Q000191:economics* / Q000453:epidemiology*; D019966:Substance-Related Disorders / Q000453:epidemiology; D013406:Suicide, Attempted / Q000191:economics; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data; D014754:Violence / Q000706:statistics & numerical data