Outpatient antipsychotic treatment and inpatient costs of schizophrenia

OBJECTIVE: To estimate the proportions of acute care inpatient admissions and hospital days for schizophrenia patients in the Medicaid program that are attributable to gaps in outpatient antipsychotic treatment and to calculate the corresponding total health care costs of this care. METHODS: A series of multivariate regressions were performed with statewide 2001-2003 California Medicaid data to estimate the fraction of acute care hospital admissions and hospital days for schizophrenia attributable to gaps in antipsychotic medication treatment. This fraction was then applied to national estimates of the number and costs of inpatient treatment episodes for patients with schizophrenia in the national Medicaid program. RESULTS: In the United States, there are roughly 87 000 annual acute care inpatient admissions of Medicaid patients for the treatment of schizophrenia. These admissions include a total of approximately 930 000 hospital days at a total cost of $806 million. Improving adherence to eliminate gaps in antipsychotic medication treatment could lower the number of acute care admissions by approximately 12.3% (95% confidence interval [CI]: 11.7%-12.6%) and reduce the number of inpatient treatment days by approximately 13.1% (CI: 9.8%-16.5%) resulting in a savings of approximately $106 million (95% CI: $79.0 million-$133.0 million) in inpatient care costs for the national Medicaid system. CONCLUSIONS: Nonadherence to antipsychotic medication treatment accounts for a considerable proportion of inpatient treatment costs of Medicaid patients with schizophrenia. Improving continuity of antipsychotic medications could lead to savings by reducing the frequency and duration of inpatient treatment.     

Economic costs of depression in China

BACKGROUND: A recent survey in China indicated the 12-month prevalence rate of depressive disorders was 2.5% in Beijing and 1.7% in Shanghai. These disorders may result in disability, premature death, and severe suffering of those affected and their families. AIMS: This study estimates the economic consequences of depressive disorders in China. METHODS: Depressive disorders can have both direct and indirect costs. To obtain direct costs, the research team interviewed 505 patients with depressive disorders and their caregivers in eight clinics/hospitals in five cities in China. Depression-related suicide rates were obtained from published literature. The human capital approach was used to estimate indirect costs. Epidemiological data were taken from available literature. RESULTS: The total estimated cost of depression in China is 51,370 million Renminbi (RMB) (or US $6,264 million) at 2002 prices. Direct costs were 8,090 million RMB (or US$ 986 million), about 16% of the total cost of depression. Indirect costs were 43,280 million RMB (or US$ 5,278 million), about 84% of the total cost of depression. CONCLUSIONS: Depression is a very costly disorder in China. The application of an effective treatment--reducing the length of depressive episodes (or preventing episodes) and reducing suicide rates--will lead to a significant reduction in the total burden resulting from depressive disorders. Government policymakers should seriously consider further investments in mental health services.     

Psychiatric inpatient,outpatient, and medication utilization and costs among privately insured youths, 1997-2000

OBJECTIVE: The study examined trends in use of inpatient and outpatient mental health services, including pharmacotherapy, among privately insured children and adolescents from 1997 to 2000. METHOD: Data from a national database of more than 1.7 million privately insured individuals were used in an analysis of inpatient, outpatient, and pharmacy claims of users of mental health care age 17 years and younger (approximately 20,000 patients per year). Annual utilization rates and adjusted costs for services and dispensed psychotropic medications were calculated. Results from 1997 and 2000 were compared across diagnostic and age categories. RESULTS: The proportion of youths with an inpatient psychiatric admission decreased by 23.7% from 1997 to 2000, and annual inpatient and outpatient costs decreased by 1,216 US dollars (18.4%) and 157 US dollars (14.4%), respectively. Decreases were driven by a reduction in inpatient days (20.0%) and by a combination of a reduction in outpatient visits (11.3%) and declining payments per outpatient visit (6.1%). Payment trends across diagnoses varied considerably, with the largest reductions seen in treatment of depression, hyperactivity, adjustment disorders, and anxiety disorders. Over the same period, the proportion of youths receiving medication increased by 4.9%, and mean annual medication-related costs per outpatient increased by 41 US dollars (12.1%). CONCLUSIONS: Reductions in inpatient and outpatient mental health service intensity and reimbursements documented in previous research continued through the late 1990s. Declines were accompanied by concurrent increases in the use of and costs associated with psychotropic medications, particularly for youths with mood and anxiety disorders. These results document a shift toward medication-based outpatient treatment modalities.     

National trends in the use of outpatient psychotherapy

OBJECTIVE: This article reports recent trends in the use of outpatient psychotherapy in the United States. METHOD: Data from the household sections of the 1987 National Medical Expenditure Survey and the 1997 Medical Expenditure Panel Survey were analyzed. Trends in the rate of psychotherapy use from these nationally representative samples are presented by age, sex, race/ethnicity, marital status, education, employment status, and income. Psychotherapy users are compared over time by provider specialty, concomitant psychotropic medication use, number of annual visits, and costs. In addition, trends in payment source and primary diagnosis are assessed for psychotherapy visits. RESULTS: Between 1987 and 1997, there was no statistically significant change in the overall rate of psychotherapy use (3.2 per 100 persons in 1987 and 3.6 per 100 in 1997). However, significant increases were observed in psychotherapy use by adults aged 55-64 years and by unemployed adults. Among psychotherapy patients, there was a marked increase in the use of antidepressant medications (14.4% to 48.6%), mood stabilizers (5.3% to 14.5%), stimulants (1.9% to 6.4%), and psychotherapy provided by physicians (48.1% to 64.7%). A smaller proportion of patients made more than 20 psychotherapy visits in 1997 (10.3%) than in 1987 (15.7%). Over this period, psychotherapy visits for mood disorders became more common. In 1997, 9.7 million Americans spent $5.7 billion on outpatient psychotherapy. CONCLUSIONS: From 1987 to 1997, access to psychotherapy in the United States remained constant overall but was characterized by increased use by some socioeconomically disadvantaged groups. However, the number of visits per user markedly decreased during this period. Psychotherapy was increasingly administered by physicians and provided in conjunction with psychotropic medications. These changes occurred during a period of expansion in the number of available psychotropic medications and growth in managed behavioral health care.     

Economic consequences of multiple sclerosis for Canadians

Objectives - To estimate the total costs of multiple sclerosis (MS) for all Canadians in 1994.
Methods - Prevalence-based study estimating disease-related societal costs for Canadians with MS in 1994. The human capital approach was used to estimate the value of lost productivity due to illness. Two components were revealed: first, direct costs, in terms of expenditures on hospital care, other institutions, physician services, other health professionals, drugs, and other expenditures; and second, indirect costs, in terms of lost productivity due to premature mortality and disability.
Results - The total costs of MS for Canadians were $502.3 million in 1994, with direct and indirect cost components at $188.6 million and $313.7 million, respectively.
Conclusions - This study highlights the scope and magnitude of the economic consequences of MS for Canadians. The costs calculated may be used to provide guidance in the setting of national priorities for research and prevention activities.     

Health service delivery and research outcomes of a common departmental structure for psychiatric consultation-liaison and social work services at a university hospital

Convincing evidence exists that psychosocial factors have a major impact on both outcome and costs in the medical/surgical services in general hospitals. This paper describes the Human Services Department's impact on social work and consultation-liaison psychiatry, using a data-based management system across five specialties: 1) social work; 2) consultation-liaison psychiatry; 3) supportive care (hospice); 4) home care (home health discharge planning); and 5) pastoral care, which offers opportunities for research and quality assurance monitoring. Time spent in service delivery was used to estimate the cost per hour: 1) pastoral care $96; 2) social work $36; 3) consultation-liaison psychiatry $59; 4) home care $49. Referral to social work was preferred for a range of family and discharge planning services. Consultation-liaison services were preferred for depression, paranoid behavior, and management problems. Referral overlap was noted for "coping with diagnosis" for social work and consultation-liaison psychiatry. Using a computerized data base format for documenting the referral process, work accomplished, and time spent among those services providing mental health care in the general hospital permits the observation of redundancy of services delivered and their costs.     

Psychotropic medication use in a national probability sample of children in the child welfare system

OBJECTIVES: The aim of this study was to estimate the point prevalence of psychotropic medication use, and to describe relationships between child-level characteristics, provider type, and medication use among children in the child welfare system. METHODS: The National Survey of Child and Adolescent Well-Being is the first nationally representative study of children coming into contact with the child welfare system. We used data from its baseline and 12-month follow-up waves, and conducted weighted bivariate analyses on a sample of 3114 children and adolescents, 87% of whom were residing in-home. RESULTS: Overall, 13.5% of children in child welfare were taking psychotropic medications in 2001-2002. Older age, male gender, Caucasian race/ethnicity, history of physical abuse, public insurance, and borderline scores on the internalizing and externalizing subscales of the Child Behavior Checklist were associated with higher proportions of medication use. African-American and Latino ethnicities, and a history of neglect, were associated with lower proportions of medication use. CONCLUSIONS: These national estimates suggest that children in child welfare settings are receiving psychotropic medications at a rate between 2 and 3 times that of children treated in the community. This suggests a need to further understand the prescribing of psychotropic medications for child welfare children.     

The economic burden of mental illness.

Mental illness imposes a substantial burden on individuals and society. Using data from national surveys and a newly developed methodology for calculating costs, the authors estimate that in 1985 the total economic costs of mental illness were $103.7 billion. Of this total, direct treatment and support costs were $42.5 billion, or 11.5 percent of total personal health care spending for all illnesses. Morbidity costs--the value of reduced or lost productivity--amounted to $47.4 billion. Mortality costs--the lost value of productivity due to premature death resulting from mental illness--were estimated to be $9.3 billion, or 5.1 percent of total productivity losses for all deaths. Other related costs, including the cost of caregiver services, amounted to $4.5 billion.     

Overuse of psychotropic medications among children and adolescents with autism spectrum disorders: perspective from a developing country

Psychopharmacotherapy can be an effective part of the treatment for individuals with autism spectrum disorders (ASDs). However debate continues over the potential benefits and costs of these treatments; additionally little is known about the pattern of psychotropic medication use in developing countries. We aimed to survey the use of psychotropic medication, their subcategories and its associations among a representative local sample of 345 Iranian pupils with ASDs. All required information about demographics as well as clinical and medication history of children was collected through interviews with the families. Overall, 80% of participants were currently using at least one psychotropic medication while, and up to 97% of the sample had at least one psychotropic medication claim during the last year. Antipsychotics were the most frequent medications (57.4%) while antidepressants were used by only a small proportion of participants (8.7%). Further analysis revealed no significant association between any psychotropic medication use on one hand and clinical and demographic characteristics on the other hand. Time differences, cross cultural variations, and also cost and availability of treatment options in developing countries are discussed as possible explanations for different patterns and more than expected rate of psychotropic medication use in pupils with ASD.