title: Assessing medication adherence and healthcare utilization and cost patterns among hospital-discharged patients with schizoaffective disorder.
abstract: BACKGROUND
  Hospital-discharged patients with schizoaffective disorder have a high risk of re-hospitalization. However, limited data exist evaluating critical post-discharge periods during which the risk of re-hospitalization is significant.
  
  
  OBJECTIVE
  Among hospital-discharged patients with schizoaffective disorder, we assessed pharmacotherapy adherence and healthcare utilization and costs during sequential 60-day clinical periods before schizoaffective disorder-related hospitalization and post-hospital discharge.
  
  
  METHODS
  From the MarketScan(®) Medicaid database (2004-2008), we identified patients (≥18 years) with a schizoaffective disorder-related inpatient admission. Study measures including medication adherence and healthcare utilization and costs were assessed during sequential preadmission and post-discharge periods. We conducted univariate and multivariable regression analyses to compare schizoaffective disorder-related and all-cause healthcare utilization and costs (in 2010 US dollars) between each adjacent 60-day post-discharge periods. No adjustment was made for multiplicity.
  
  
  RESULTS
  We identified 1,193 hospital-discharged patients with a mean age of 41 years. The mean medication adherence rate was 46% during the 60-day period prior to index inpatient admission, which improved to 80% during the 60-day post-discharge period. Following hospital discharge, schizoaffective disorder-related healthcare costs were significantly greater during the initial 60-day period compared with the 61- to 120-day post-discharge period (mean US$2,370 vs US$1,765; p < 0.001), with rehospitalization (36%) and pharmacy (40%) accounting for over three-fourths of the initial 60-day period costs. Compared with the initial 60-day post-discharge period, both all-cause and schizoaffective disorder-related costs declined during the 61- to 120-day post-discharge period and remained stable for the remaining post-discharge periods (days 121-365).
  
  
  CONCLUSIONS
  We observed considerably lower (46%) adherence during 60 days prior to the inpatient admission; in comparison, adherence for the overall 6-month period was 8% (54%) higher. Our study findings suggest that both short-term (e.g., 60 days) and long-term (e.g., 6-12 months) medication adherence likely are important characteristics to examine among patients with schizoaffective disorder and help provide a more holistic view of patients' adherence patterns. Furthermore, we observed a high rate of rehospitalization and greater healthcare costs during the initial 60-day period post-discharge among patients with schizoaffective disorder. Further research is required to better understand and manage transitional care after discharge (e.g., monitor adherence), which may help reduce the likelihood of rehospitalization and the associated downstream costs.
authors.affiliation: , Germantown, MD, USA, sudeepkarve@gmail.com.
authors.forename: Sudeep
authors.initials: S
authors.lastname: Karve
authors.forename: Michael
authors.initials: M
authors.lastname: Markowitz
authors.forename: Dong-Jing
authors.initials: DJ
authors.lastname: Fu
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Lindenmayer
authors.forename: Chi-Chuan
authors.initials: CC
authors.lastname: Wang
authors.forename: Sean D
authors.initials: SD
authors.lastname: Candrilli
authors.forename: Larry
authors.initials: L
authors.lastname: Alphs
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000191:economics / Q000627:therapeutic use; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data*; D016527:Drug Costs; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D011618:Psychotic Disorders / Q000188:drug therapy / Q000191:economics* / Q000523:psychology; D012189:Retrospective Studies; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D014150:Antipsychotic Agents
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