Risk factors for relapse in patients with first-episode schizophrenia: Analysis of the Health Insurance Review and Assessment Service data from 2011 to 2015

Sun

et al. 2018

Int J Ment Health Syst

BackgroundSchizophrenia is one of the leading public health issues in psychiatry and imposes a heavy financial burden on the healthcare systems. This study aims to report the direct medical costs and the associated factors for patients with schizophrenia in Guangzhou city, Southern China.MethodsThis was a retrospective 4-year cohort study. Data were obtained from urban health insurance claims databases of Guangzhou city, which contains patients’ sociodemographic characteristics, direct medical costs of inpatient and outpatient care. The study cohort (including all the reimbursement claims submitted for schizophrenia inpatient care during November 2010 and October 2014) was identified using the International Classification of Diseases Tenth version (F20). Their outpatient care information was merged from outpatient claims database. Descriptive analysis and the multivariate regression analysis based on Generalized Estimating Equations model were conducted.ResultsA total of 2971 patients were identified in the baseline. The cohort had a mean age of 50.3 years old, 60.6% were male, and 67.0% received medical treatment in the tertiary hospitals. The average annual length of stay was 254.7 days. The average annual total direct medical costs per patient was 41,972.4 Chinese Yuan (CNY) ($6852.5). The inpatient costs remained as the key component of total medical costs. The Urban Employee Basic Medical Insurance enrollees with schizophrenia had higher average costs for hospitalization (CNY42,375.1) than the Urban Resident Basic Medical Insurance enrollees (CNY40,917.3), and had higher reimbursement rate (85.8% and 61.5%). The non-medication treatment costs accounted for the biggest proportion of inpatient costs for both schemes (55.8% and 64.7%). Regression analysis suggested that insurance type, age, hospital levels, and length of stay were significantly associated with inpatient costs of schizophrenia.ConclusionsThe direct annual medical costs of schizophrenia were high and varied by types of insurance in urban China. The findings of this study provide vital information to understand the burden of schizophrenia in China. Results of this study can help decision-makers assess the financial impact of schizophrenia.

Section: Discussionmentioning

confidence: 99%

Direct medical costs for patients with schizophrenia: a 4-year cohort study from health insurance claims data in Guangzhou city, Southern China

Sun

et al. 2018

Int J Ment Health Syst

Psychiatry Clin Neurosci

“…We performed Cox proportional hazard regressions to examine the risk of treatment discontinuation and psychiatric hospitalization associated with antipsychotic dose reduction, with the covariates reported as risk factors for relapse in FES in a previous study using the HIRA database. 31 However, some limitations should be considered in interpreting our results. First, we arbitrarily investigated antipsychotic dose at 6 months to determine the magnitude of antipsychotic dose reduction.…”

Section: Discussionmentioning

confidence: 94%

Risk of treatment discontinuation and psychiatric hospitalization associated with early dose reduction of antipsychotic treatment in first‐episode schizophrenia: A nationwide, health insurance data–based study

Joo

Kim

et al. 2022

Aim We investigated the impact of early dose reduction of antipsychotic treatment on the risk of treatment discontinuation and psychiatric hospitalization in patients with first‐episode schizophrenia (FES). Methods The Health Insurance Review Agency database in South Korea was used to include 16 153 patients with FES. At 6 months from their diagnosis, the patients were categorized by the magnitude of dose reduction (no reduction, 0%–50%, and >50%). With a reference of no reduction, the risk of treatment discontinuation and psychiatric hospitalization associated with dose reduction in the 1‐year follow‐up period after the first 6 months was examined with a Cox proportional hazard ratio model stratified by the mean daily olanzapine‐equivalent dose in the first 3 months (<10, 10 to 20, >20 mg/day). Results A >50% dose reduction was associated with an increased risk of treatment discontinuation in all subgroups (<10 mg/day: hazard ratio [HR] =1.44, 95% confidence interval [CI] =1.24–1.67 [P <0.01]; 10–20 mg/day: HR =1.60, 95% CI =1.37–1.86 [P <0.01]; and >20 mg/day: HR =1.62, 95% CI =1.37–1.91 [P <0.01]). In the subgroup taking <10 mg/day, an association of 0%–50% dose reduction with an increased risk of treatment discontinuation was observed (HR =1.20, 95% CI =1.09–1.31; P <0.01). A > 50% dose reduction was associated with increased risk of psychiatric hospitalization only in the subgroup taking <10 mg/day (HR =1.48, 95% CI =1.21–1.80; P <0.01). Conclusions Our results suggest that an above certain dose of antipsychotic drugs is required to prevent psychiatric hospitalization, and extensive dose reduction of antipsychotic drugs could result in a higher risk of treatment discontinuation.

“…For example, recurrence was defined as additional surgery or chemotherapy after transurethral resection of a bladder tumor in a study of bladder cancer treatment patterns [33]. In addition, recurrence was defined as admission during follow-up after completion of initial treatment in a study of risk factors for schizophrenia recurrence [34]. Finally, since the information on HT duration from HIRA data was inaccurate, the dose dependent effect was not evaluated in the study.…”

Section: Discussionmentioning

confidence: 99%

Effects of hormone therapy on recurrence in endometrial cancer survivors: a nationwide study using the Korean Health Insurance Review and Assessment Service database

2019

Objective The aim of this study was to verify the effects of hormone therapy (HT) on recurrence in endometrial cancer (EC) survivors using the Korean Health Insurance Review and Assessment Service (HIRA) database. Methods Using the HIRA claims database, we identified all Korean women who were newly diagnosed with EC and underwent surgical staging between 2010 and 2013. Patient characteristics such as age, HT exposure, lymphadenectomy, and adjuvant therapy were evaluated. Cox proportional hazards models were used to estimate the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the recurrence of EC. Results The mean follow-up time of all 5,667 eligible patients was 47.5 months. Of these, 847 (14.9%) received HT. Recurrence was seen in 446 (7.8%) patients. Univariate analysis revealed an increased recurrence rate in patients older than 50 years (HR=2.05; 95% CI=1.62–2.63), patients with high-risk EC (HR=24.51; 95% CI=18.63–32.35), and patients who underwent lymphadenectomy (HR=1.52; 95% CI=1.21–2.03), and a reduced recurrence rate in patients who received HT (HR=0.62; 95% CI=0.46–0.83). Multivariate analysis confirmed the significant increase in recurrence in patients older than 50 years (HR=1.47; 95% CI=1.14–1.89) and in patients with high-risk EC (HR=23.90; 95% CI=18.12–31.51). HT did not increase the recurrence rate of EC (HR=0.81; 95% CI=0.31–2.10). Conclusion This study demonstrates that HT does not increase disease recurrence in EC survivors, despite lack of data that could affect the outcome.