OBJECTIVES:

To examine healthcare resource utilization (HCRU) and costs among patients with schizophrenia and schizoaffective disorder by relapse frequency.

METHODS:

Patients ≥12 years with naïve schizophrenia or schizoaffective disorder (index date) between 01/01/2014 and 08/31/2020 and continuous medical and pharmacy enrollment for one year before and after index date were identified from the HealthCore Integrated Research Database. Patients were stratified by relapse frequency within one-year post-index: 0 relapses, 1 relapse, and ≥2 relapses (defined as inpatient encounters for schizophrenia/schizoaffective disorder or emergency room encounters for psychiatric disorders). HCRU and costs were examined by relapse cohort and payor (commercial, Medicare Advantage/Supplemental, or Medicaid). Multivariable generalized linear models with gamma distribution and log-link functions were used to estimate adjusted post-index costs by relapse cohort.

RESULTS:

Among 6,634 commercial/Medicare enrolled patients, 74%, 17%, and 10% experienced 0, 1, and ≥2 relapses, respectively. Among 4,858 Medicaid enrolled patients, 63%, 19%, and 18% experienced 0, 1, and ≥2 relapses, respectively. All patients were in their 30s, with relatively equal distribution by sex. For both payors, HCRU significantly increased by relapse frequency, including the mean number of post-index inpatient hospitalizations (commercial/Medicare: 0.8, 1.9, 3.1; Medicaid: 0.8, 1.5, 3.3), emergency room (commercial/Medicare: 0.5, 1.5, 4.2; Medicaid: 1.0, 2.3, 6.0), and office visits (commercial/Medicare: 9.8, 10.7, 13.4; Medicaid: 7.6, 8.2, 9.1). Total cost increased from baseline to post-index by between 60% and 138% across all relapse cohorts and payors. In adjusted models, post-index mean total costs were significantly greater among those with 1 and ≥2 relapses than 0 relapses for all payors (commercial/Medicare: $28,803, $49,253, $62,908; Medicaid: $19,416, $28,219, $41,929).

CONCLUSIONS:

Patients with schizophrenia or schizoaffective disorder have high HCRU and costs, which increase with relapse frequency. This illustrates the high burden and unmet need for managing this disease and opportunities to improve care for these underserved patients