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Applied Health Economics and Health Policy
Published in: Applied Health Economics and Health Policy 3/2014

Open Access 01-06-2014 | Original Research Article

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

Authors: Sudeep Karve, Michael Markowitz, Dong-Jing Fu, Jean-Pierre Lindenmayer, Chi-Chuan Wang, Sean D. Candrilli, Larry Alphs

Published in: Applied Health Economics and Health Policy | Issue 3/2014

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Abstract

Background

Hospital-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.

Objective

Among 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.

Methods

From 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.

Results

We 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).

Conclusions

We 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.
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Metadata
Title
Assessing Medication Adherence and Healthcare Utilization and Cost Patterns Among Hospital-Discharged Patients with Schizoaffective Disorder
Authors
Sudeep Karve
Michael Markowitz
Dong-Jing Fu
Jean-Pierre Lindenmayer
Chi-Chuan Wang
Sean D. Candrilli
Larry Alphs
Publication date
01-06-2014
Publisher
Springer International Publishing
Published in
Applied Health Economics and Health Policy / Issue 3/2014
Print ISSN: 1175-5652
Electronic ISSN: 1179-1896
DOI
https://doi.org/10.1007/s40258-014-0095-8

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