title: Effects of medication adherence on hospitalizations and healthcare costs in patients with schizophrenia in Thailand.
abstract: BACKGROUND
  This study was conducted to determine the impacts of medication adherence on hospitalization and direct healthcare cost in patients with schizophrenia in Thailand.
  
  
  METHODS
  A retrospective study was undertaken. Patients with schizophrenia aged 18-65 years who visited a University hospital and received antipsychotics from April 2011 to October 2011 were included. Propensity score-adjusted logistic regression was used to determine the impacts of medication adherence on schizophrenia-related and all-cause hospitalizations.
  
  
  RESULTS
  A total of 582 patients were included. Three out of 224 patients (1.3%) were hospitalized with schizophrenia in optimal adherence group, while 10 of 140 (7.1%) were hospitalized in under-adherence group, and 7 of 218 (3.2%) were hospitalized in over-adherence group. Based on propensity score-adjusted multivariate logistic regression, the adjusted odds ratio was 5.86 (95% confidence interval = 1.53-22.50) for schizophrenia-related hospitalization and 8.04 (95% confidence interval = 2.20-29.40) for all-cause hospitalization. The average annual direct healthcare costs in patients with optimal adherence, under-adherence, and over-adherence were US$371 ± US$836, US$386 ± US$734, and US$508 ± US$2168, respectively.
  
  
  CONCLUSIONS
  An initiation of interventions to maintain optimal adherence in patients with schizophrenia would significantly impact the healthcare system.
authors.affiliation: Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.
authors.forename: Piyameth
authors.initials: P
authors.lastname: Dilokthornsakul
authors.affiliation: Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia.
authors.forename: Thitaporn
authors.initials: T
authors.lastname: Thoopputra
authors.affiliation: Department of Health Informatics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Oraluck
authors.initials: O
authors.lastname: Patanaprateep
authors.affiliation: Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Ronnachai
authors.initials: R
authors.lastname: Kongsakon
authors.affiliation: Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia; School of Population Health, University of Queensland, Brisbane, QLD, Australia; School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: Nathorn
authors.initials: N
authors.lastname: Chaiyakunapruk
keywords: Adherence; antipsychotics; cost; hospitalization