title: Health care resource utilization and direct medical costs for patients with schizophrenia initiating treatment with atypical versus typical antipsychotics in Tianjin, China.
abstract: BACKGROUND
  It is uncertain whether the extra acquisition costs of atypical antipsychotics over typical antipsychotics are offset by their other reduced resource use especially in hospital services in China. This study compared the psychiatric-related health care resource utilization and direct medical costs for patients with schizophrenia initiating atypical or typical antipsychotics in Tianjin, China.
  
  
  METHODS
  Data were obtained from the Tianjin Urban Employee Basic Medical Insurance database (2008-2010). Adult patients with schizophrenia with ≥1 prescription for antipsychotics after ≥90-day washout and 12-month continuous enrollment after first prescription was included. Psychiatric-related resource utilization and direct medical costs of the atypical and typical cohorts were estimated during the 12-month follow-up period. Logistic regressions, ordinary least square (OLS), and generalized linear models (GLM) were employed to estimate differences of resource utilization and costs between the two cohorts. One-to-one propensity score matching was conducted as a sensitivity analysis.
  
  
  RESULTS
  1131 patients initiating either atypical (N = 648) or typical antipsychotics (N = 483) were identified. Compared with the typical cohort, the atypical cohort had a lower likelihood of hospitalization (45.8% vs. 56.7%, P < 0.001; adjusted OR: 0.58, P < 0.001) over the follow-up period. Medication costs for the atypical cohort were higher than the typical cohort ($438 vs. $187, P < 0.001); however, their non-medication medical costs were significantly lower ($1223 vs. $1704, P < 0.001). The total direct medical costs were similar between the atypical and typical cohorts before ($1661 vs. $1892, P = 0.100) and after matching ($1711 vs. 1868, P = 0.341), consistent with the results from OLS and GLM models for matched cohorts.
  
  
  CONCLUSIONS
  The atypical cohort had similar total direct medical costs compared to the typical cohort. Higher medication costs associated with atypical antipsychotics were offset by a reduction in non-medication medical costs, driven by fewer hospitalizations.
authors.affiliation: School of Pharmaceutical Science and Technology, Tianjin University, No 92 Weijin Road, Nankai District, Tianjin, China. n19900118@163.com.
authors.forename: Xiaoning
authors.initials: X
authors.lastname: He
authors.affiliation: School of Pharmaceutical Science and Technology, Tianjin University, No 92 Weijin Road, Nankai District, Tianjin, China. jingwu@tju.edu.cn.
authors.forename: Jing
authors.initials: J
authors.lastname: Wu
authors.affiliation: Department of Clinical Pharmacy and Pharmaceutical Economics and Policy, School of Pharmacy, University of Southern California, Los Angeles, CA, USA. yawenjia@usc.edu.
authors.forename: Yawen
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: Lilly Suzhou Pharmaceutical Company, Ltd., Shanghai, China. liuli_lucy@163.com.
authors.forename: Li
authors.initials: L
authors.lastname: Liu
authors.affiliation: Lilly Suzhou Pharmaceutical Company, Ltd., Shanghai, China. ye_wendy_wenyu@lilly.com.
authors.forename: Wenyu
authors.initials: W
authors.lastname: Ye
authors.affiliation: Lilly Suzhou Pharmaceutical Company, Ltd., Shanghai, China. 13816715862@139.com.
authors.forename: Haibo
authors.initials: H
authors.lastname: Xue
authors.affiliation: Eli Lilly and Company, Sydney, Australia. montgomery_bill@lilly.com.
authors.forename: William
authors.initials: W
authors.lastname: Montgomery
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000191:economics* / Q000627:therapeutic use*; D002681:China; D015331:Cohort Studies; D016527:Drug Costs / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012559:Schizophrenia / Q000188:drug therapy* / Q000191:economics*; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents