Crowe Christopher L, Xiang Pin, Smith Joseph L, Pizzicato Lia N, Gloede Tristan, Yang Yiling, Teng Chia-Chen, Isenberg Keith
Carelon Research, 123 Justison Street, Suite 200, Wilmington, DE, 19801, USA.
Boehringer Ingelheim Pharmaceuticals, Inc., 900 Ridgebury Road, Ridgefield, CT, 06877, USA.
Schizophrenia (Heidelb). 2024 Oct 4;10(1):86. doi: 10.1038/s41537-024-00509-6.
Schizophrenia and schizoaffective disorder present burdens to patients and health systems through elevated healthcare resource utilization (HCRU) and costs. However, there is a paucity of evidence describing these burdens across payor types. To identify unmet needs, this study characterized patients with schizophrenia or schizoaffective disorder by payor type. We identified patients aged 12-94 years with newly diagnosed schizophrenia or schizoaffective disorder (index date) between 01/01/2014 and 08/31/2020 with continuous enrollment for 12 months before and after index date from the Healthcare Integrated Research Database. After stratifying by post-index relapse frequency (0, 1, or ≥2) and payor type (commercial, Medicare Advantage/Supplemental (Medigap)/Part D, or managed Medicaid), we examined patient characteristics, treatment patterns, HCRU, costs, and relapse patterns and predictors. During follow-up, 25% of commercial patients, 29% of Medicare patients, and 37% of Medicaid patients experienced relapse. Atypical antipsychotic discontinuation was most common among Medicaid patients, with 65% of these patients discontinuing during follow-up. Compared to commercial patients, Medicare and Medicaid patients had approximately half as many psychotherapy visits during follow-up (12 vs. 5 vs. 7 visits, respectively). Relative to baseline, average unadjusted all-cause costs during follow-up increased by 105% for commercial patients, 66% for Medicare patients, and 77% for Medicaid patients. Patients with schizophrenia or schizoaffective disorder had high HCRU and costs but consistently low psychotherapy utilization, and they often discontinued pharmacologic therapy and experienced relapse. These findings illustrate the high burden and unmet need for managing these conditions and opportunities to improve care for underserved patients.
精神分裂症和分裂情感性障碍通过提高医疗资源利用率（HCRU）和成本给患者及医疗系统带来负担。然而，缺乏关于不同支付方类型所承担这些负担的证据。为了确定未满足的需求，本研究按支付方类型对精神分裂症或分裂情感性障碍患者进行了特征描述。我们从医疗综合研究数据库中识别出2014年1月1日至2020年8月31日期间新诊断为精神分裂症或分裂情感性障碍（索引日期）的12 - 94岁患者，这些患者在索引日期前后连续登记12个月。在按索引后复发频率（0、1或≥2）和支付方类型（商业保险、医疗保险优势计划/补充医保（医疗补助）/D部分或管理式医疗补助）进行分层后，我们检查了患者特征、治疗模式、HCRU、成本以及复发模式和预测因素。在随访期间，25%的商业保险患者、29%的医疗保险患者和37%的医疗补助患者经历了复发。非典型抗精神病药物停药在医疗补助患者中最为常见，其中65%的患者在随访期间停药。与商业保险患者相比，医疗保险和医疗补助患者在随访期间的心理治疗就诊次数约为其一半（分别为12次、5次和7次）。相对于基线，随访期间商业保险患者未调整的全因平均成本增加了105%，医疗保险患者增加了66%，医疗补助患者增加了77%。患有精神分裂症或分裂情感性障碍的患者HCRU和成本较高，但心理治疗利用率一直较低，他们经常停用药物治疗并经历复发。这些发现说明了管理这些疾病的高负担和未满足的需求，以及改善对服务不足患者护理的机会。
