Prevalence, incidence and economic burden of schizophrenia among Medicaid beneficiaries

Abstract

Objective

To estimate the prevalence, incidence and economic burden of schizophrenia among Medicaid beneficiaries.

Methods

Annual prevalence and incidence of schizophrenia among adult Medicaid beneficiaries were estimated during 2012–2017, by state and across six states (IA, KS, MS, MO, NJ and WI). The pooled estimate of the economic burden of schizophrenia was obtained during 1998Q1–2018Q1 across six states; adults with ≥2 diagnoses of schizophrenia were matched 1:1 to schizophrenia-free controls. The last observed schizophrenia diagnosis (schizophrenia cohort) or the last service claim (control cohort) with ≥12 months of continuous Medicaid enrollment before/after it defined the index date. Healthcare resource utilization (HRU) and costs ($2018 USD) incurred 12 months post-index were compared between cohorts. The economic burden of schizophrenia was also evaluated among young adults (18–34 years).

Results

Annual prevalence of schizophrenia ranged between 2.30% and 2.71% and annual incidence between 0.31% and 0.39% during 2012–2016. In 2017, only states with the highest incidence and prevalence rates (KS, MS, MO) had data, resulting in higher prevalence (4.01%) and incidence (0.52%). For the economic burden, adults with schizophrenia (N = 158,763) had higher HRU and incurred $14,087 higher healthcare costs versus controls (mean: $28,644 vs. $14,557), driven by $4677 higher long-term care costs (all p < .001). Young adults with schizophrenia incurred $14,945 higher healthcare costs versus controls, driven by $3473 higher inpatient costs (p < 0.001).

Conclusions

Annual prevalence and incidence of schizophrenia varied by state but remained stable over time. Adults with schizophrenia incurred greater HRU and costs relative to adults without schizophrenia; the burden appeared comparable among young adults.

Keywords:

• Cost
• economic burden
• healthcare resource utilization
• incidence Medicaid
• prevalence
• schizophrenia

Transparency

Declaration of funding

Janssen Scientific Affairs LLC funded the development and conduct of this study and manuscript. The sponsor was involved in the study design, interpretation of results, manuscript preparation and publication decisions.

Declaration of financial/other relationships

C.P., D.L. and K.J. have disclosed that they are employees of Janssen Scientific Affairs LLC and hold stock in Johnson & Johnson. D.P., M.H.L., M.Z., A.C.S., C.R. and P.L. have disclosed that they are employees of Analysis Group Inc., a consulting company that has provided paid consulting services to Janssen Scientific Affairs LLC for the conduct of this study. CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

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 Loraine Georgy PhD and Christine Tam MSc, employees of Analysis Group Inc., a consulting company that has provided paid consulting services to Janssen Scientific Affairs LLC.