National and regional description of healthcare measures among adult Medicaid beneficiaries with schizophrenia within the United States

Abstract

Aims

Provide the first national description across the US of variations in healthcare measures in 2018 among Medicaid beneficiaries with schizophrenia.

Materials and methods

Adult beneficiaries with ≥2 diagnoses for schizophrenia, and continuous enrollment with consistent geographical data in all of 2018 were identified from Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) data for 45 of 50 states. Antipsychotic (AP) utilization rates, including long-acting injectable APs (LAIs), quality metrics, and all-cause healthcare resource utilization and costs for claims submitted to Medicaid were reported nationally and by state. Pearson correlation evaluated associations between LAI utilization and total healthcare costs at state and county levels.

Results

Across the US 688,437 patients with schizophrenia were identified. The AP utilization rate was 51% (state range: 24–77%), while the LAI utilization rate was 13% (range: 4–26%). The proportion of patients adherent to any AP was 56% (range: 19–73%). Within 30 days post-discharge from an inpatient admission, 22% (range: 8–58%) of patients had an outpatient visit, and 12% (range: 4–48%) had a readmission. The proportion of patients with ≥1 inpatient admission and ≥1 emergency room visit was 34% (range: 19–82%) and 45% (range: 20–70%). Per-patient-per-year total healthcare costs averaged $32,920 (range: $717–$93,972). At the county level, a weak negative correlation was observed between LAI utilization and total healthcare costs.

Limitations

This study included Medicaid beneficiaries enrolled with pharmacy and medical benefits, including beneficiaries dually eligible for Medicare; results cannot be generalized to the overall schizophrenia population or those with other payer coverage.

Conclusions

In 2018, half of beneficiaries with schizophrenia did not submit any claims for APs to Medicaid, nearly half had an emergency room visit, and one-third had an inpatient admission. Moreover, healthcare measures varied considerably across states. These findings may indicate unmet treatment needs for Medicaid beneficiaries with schizophrenia.

PLAIN LANGUAGE SUMMARY

Schizophrenia is a severe mental disorder that poses a large health, social, and cost burden to patients and society. While treatment with antipsychotic medications can reduce the number of relapses and hospitalizations, many patients do not adhere to treatment, which can lead to poor symptom control and further use of healthcare services. Interestingly, these measures of schizophrenia care seem to vary across US states. Therefore, we ran the first study to describe the regional differences in antipsychotic use, measures of quality of care, healthcare use, and healthcare costs among Medicaid-insured patients across the US in 2018.

Our results showed that only half of patients used antipsychotics in 2018 (with a range of 24–77% across states) and the proportion of patients adherent to antipsychotic treatment was low (range of 19–73%). Additionally, nearly half of all patients had an emergency room visit (range of 20–70%), and one-third had an inpatient admission (range of 19–82%). These findings highlight large variations in antipsychotic use, performance measures, and healthcare use, possibly due to regional differences in unmet needs in schizophrenia care for Medicaid-insured patients in the US. Since use of inpatient and emergency room services was consistently high in specific states or regions, and yearly healthcare costs per patient varied from $717–$93,972 (mean = $32,920), there may be a particularly high burden in certain areas of the country where patients with schizophrenia may potentially be experiencing multiple relapses. Further research is needed to identify policies that may help narrow these regional differences.

Keywords:

• Adherence
• antipsychotic medication
• healthcare costs
• long-acting injectable
• Medicaid
• schizophrenia

JEL Classification Codes:

• I10
• I1
• I
• I00

Transparency

Declaration of funding

This study was supported by Janssen Scientific Affairs, LLC. The sponsor was involved in the study design, interpretation of results, manuscript preparation, and publication decisions.

Declaration of financial/other relationships

CP and CB are employees of Janssen Scientific Affairs, LLC and stockholders of Johnson & Johnson. DP, DG, LM, MHL, and PL are employees of Analysis Group, Inc., a consulting company that has provided paid consulting services to Janssen Scientific Affairs, LLC, which funded the development and conduct of this study and manuscript.

A reviewer on this manuscript has disclosed that they have received manuscript or speaker’s fees from Astellas, Dainippon Sumitomo Pharma, Eisai, Eli Lilly, Elsevier Japan, Janssen Pharmaceuticals, Kyowa Yakuhin, Lundbeck Japan, Meiji Seika Pharma, Mitsubishi Tanabe Pharma, MSD, Nihon Medi-Physics, Novartis, Otsuka Pharmaceutical, Shionogi, Shire, Takeda Pharmaceutical, Tsumura, Wiley Japan, and Yoshitomi Yakuhin, and research grants from Dainippon Sumitomo Pharma, Eisai, Mochida Pharmaceutical, Meiji Seika Pharma and Shionogi.

All the peer reviewers on this manuscript have received an honorarium from JME for their review work but have no other relevant financial relationships to disclose.

The Deputy Editor in Chief helped with adjudicating the final decision on this paper.

Author contributions

All authors were involved in the following aspects of the research: the conception and design of the study, or analysis and interpretation of the data; drafting of the paper and revising it critically for intellectual content; and the decision to submit the manuscript for publication. All authors agree to be accountable for all aspects of the work.

Acknowledgements

Medical writing support was provided by a professional medical writer, Christine Tam, an employee of Analysis Group, Inc. Additional support for manuscript review and interpretation of data was provided by Shannon Grabich, an employee of Xcenda (AmerisourceBergen), and Crystal Murcia, owner of Inkwell Medical Communications LLC.

Previous presentation

Part of the material in this manuscript was presented at the Psych Congress held on 10–13 September 2020, as a virtual poster presentation.

Data set

The data that support the findings of this study are available in the supplementary files.

Notes

i Data related to AP and SGA utilization were not reported for Nebraska given low rates of observed OAP use, suggesting that OAP claims data may be incomplete. Data related to AP and SGA utilization were not reported in Utah given the small population of patients identified for the study. For example, the proportion of patients with LAI use was censored based on CMS reporting criteria.