Assessing Medication Adherence and Healthcare Utilization and Cost Patterns Among Hospital-Discharged Patients with Schizoaffective Disorder

Abstract

BackgroundHospital-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.ObjectiveAmong 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.MethodsFrom 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.ResultsWe 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).ConclusionsWe 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.Electronic supplementary materialThe online version of this article (doi:10.1007/s40258-014-0095-8) contains supplementary material, which is available to authorized users.

Paliperidone Palmitate Once-Monthly Reduces Risk of Relapse of Psychotic, Depressive, and Manic Symptoms and Maintains Functioning in a Double-Blind, Randomized Study of Schizoaffective Disorder

“…20,21 Although some individuals with schizoaffective disorder achieve and maintain symptom stability with available oral antipsychotics and mood stabilizers or antidepressants, many have difficulty adhering to a daily oral regimen. 22 Long-acting injectable therapies, such as once-monthly paliperidone palmitate (paliperidone monthly), provide consistent therapeutic plasma concentrations over several weeks, eliminating the need for daily oral medication and facilitating monitoring of treatment adherence. 23,24 Building on efficacy data of oral paliperidone in acute management of schizoaffective disorder, 5,6 this relapse-prevention study was designed to compare paliperidone monthly given as monotherapy or with adjunctive antidepressants or mood stabilizers to placebo in patients with schizoaffective disorder.…”

Factors Associated with Costs of Hospitalization of Severely Mentally Ill Patients

“…Excluding dementias, they occur at a combined lifetime prevalence of nearly 5% for psychotic and bipolar disorders and approximately 10% for major depressive disorder [1][2][3]. As largely chronic or recurrent illnesses, they carry high risks of disability and early mortality, in addition to representing extraordinary direct (care) and indirect (disability) costs to society [4][5][6][7][8][9][10][11].…”

“…As largely chronic or recurrent illnesses, they carry high risks of disability and early mortality, in addition to representing extraordinary direct (care) and indirect (disability) costs to society [4][5][6][7][8][9][10][11]. Such disorders particularly during acute dysfunction, dangerousness, and with commonly co-occurring general medical illness represent the most frequent reason for hospitalization in psychiatric units of general hospitals as well as specialized institutions [2,3,[12][13][14]. Moreover, the costs would be far larger if not for the major diversion of the severely mentally ill to the criminal justice system, particularly in the US [15][16][17][18].…”

“…Such efforts aim to improve allocation of services that address such risk factors, as well as predicting and managing costs associated with illnesses that require more intensive treatment [3,11,40,[43][44][45]. Proposed risk factors for psychiatric hospitalization include repeated occurrences or exacerbations of illness, greater overall illness severity, disability and poverty, as well as suspected non-adherence to recommended treatment [46][47][48][49][50][51][52][53].…”

Estimated medical cost reductions for paliperidone palmitate vs placebo in a randomized, double-blind relapse-prevention trial of patients with schizoaffective disorder

“…However, the complexity of the disease makes sub-standard management (e.g. polypharmacy) of patients with schizoaffective disorder a high likelihood 6,7 . The Olfson et al 4 study did observe that patients with schizoaffective disorder were significantly more likely to be prescribed mood stabilizers, anxiolytics, and antidepressants than patients with schizophrenia.…”