OBJECTIVES : Schizophrenia is a chronic mental illness with an average age of onset in young adulthood. This study assessed incremental healthcare resource use (HRU) and costs associated with schizophrenia among young adults with Medicaid coverage.

METHODS : Adults with ≥2 schizophrenia diagnoses and controls without schizophrenia were identified in Medicaid data (Q1/1998-Q1/2018) from six states. The index date was the last observed schizophrenia diagnosis (cohort with schizophrenia) or the last service claim (control cohort) with ≥12 months of continuous Medicaid enrollment before and after it. Cohorts were matched 1:1 using propensity scores. Analyses were then restricted to 18-35 years old patients with schizophrenia and their matched controls. Per-patient-per-year HRU and costs ($2018 US dollars) in the 12-month post-index period were compared between matched pairs of young adults using regression models adjusted for unbalanced baseline characteristics. P-values were estimated using non-parametric bootstrap procedures.

RESULTS : Of all selected patients with schizophrenia, 29,271 (18.4%) were 18-35 years old (mean age 28.0 years; 61.9% male). Young adults with schizophrenia had 3.3 times more inpatient stays, 2.7 times more long-term care stays, 2.6 times more emergency room visits, and 1.9 times more outpatient visits relative to controls (all p<0.01); they incurred adjusted incremental healthcare costs of $14,945 versus controls (mean: $22,855 vs $8,142; p<0.01). Incremental costs were predominantly driven by inpatient ($3,473) and pharmacy ($2,609) costs (all p<0.01). While total incremental costs of young adults with schizophrenia were comparable to those of all patients with schizophrenia ($14,087), incremental inpatient costs of young adults were higher than those of all patients with schizophrenia ($2,044) and incremental long-term care costs were lower (overall cohort: $4,677).

CONCLUSIONS : Medicaid beneficiaries aged 18-35 years old with schizophrenia incurred substantial incremental HRU and costs relative to controls without schizophrenia. Incremental costs of young adults appeared comparable to those of all patients with schizophrenia.