Schizophrenia Relapse Trends and Treatment Adherence Across Different Health Plans

TL/DR –

The study looks at patients with commercial, Medicare Advantage/Supplemental, or managed Medicaid health plans who have been diagnosed with schizophrenia or schizoaffective disorder, focusing on key characteristics and predictors of relapse by payer type. The study found that most patients do not have any relapses in the 12 months following their initial diagnosis, but relapse was most common among Medicaid patients. Despite current guidelines recommending both pharmacologic and non-pharmacologic treatments, less than half of Medicare and Medicaid patients received any psychotherapy and even fewer patients received psychotherapy regularly.

Prediction and Characteristics of Relapse in Schizophrenia Patients Across Different Health Plans

This investigation identified patients in commercial, Medicare Advantage, Medigap, Part D, or managed Medicaid health plans who were newly diagnosed with schizophrenia or schizoaffective disorder. The study describes their key characteristics and relapse predictors by payor type. Relapse was most common amongst Medicaid patients, despite most patients not experiencing relapses in the first year after their initial diagnosis. Atypical antipsychotic medications were most commonly used for treatment, with adherence to these medications linked with fewer relapses. Unfortunately, treatment discontinuation was common, particularly among Medicaid patients.

Although current guidelines recommend both pharmacological and non-pharmacological treatments, less than half of Medicare and Medicaid patients received any psychotherapy. Even fewer patients received regular psychotherapy. The healthcare resource utilization (HCRU) and costs increased with relapse frequency. Health burden remained significant, even among patients who had no relapses, with approximately half of these patients being hospitalized at least once after their diagnosis, independent of payor type.

Various characteristics predicted relapse across all payor types, including having an initial diagnosis in an inpatient or ER setting, having certain comorbidities (nicotine dependence, suicidal ideation, and asthma), and the number of prior relapses. Age over 45 at the time of the initial diagnosis predicted a lower risk of relapse. Conversely, factors such as time-varying medication adherence did not consistently predict relapse across payor types.

Findings Support High Resource Utilization and Costs

Earlier research has shown that, although rare, schizophrenia and schizoaffective disorder are linked with considerable HCRU and costs. An example is the findings of Nicholl and colleagues who discovered that 22% of newly diagnosed commercial patients with schizophrenia were hospitalized during the 12 months following the diagnosis. In contrast, this study found that the percentage was significantly higher (65%) with high utilization also observed amongst Medicare and Medicaid patients. Regarding costs, annual healthcare costs for patients with schizophrenia or schizoaffective disorder averaged about $30,000 across payor types. In contrast, this study found the average unadjusted total post-index costs to be highest among commercial patients.

Non-Adherence to Antipsychotic Medications and Its Effect on Relapse

Previous research has found non-adherence to be a significant predictor of relapse after first episode psychosis. Results from this study align with this finding showing that patients who were adherent to typical and atypical antipsychotics over the duration of follow-up generally had fewer relapses. However, for Medicare and Medicaid patients, adherence to any class of antipsychotic medication was not associated with a reduced risk of relapse. But for commercial patients, adherence to atypical antipsychotics was linked to a lower risk of relapse.

Low Utilization of Non-Pharmacologic Treatments

This study also highlights the consistently low use of non-pharmacologic treatments, such as psychotherapy, among patients with schizophrenia or schizoaffective disorder. However, fewer than half of patients received psychotherapy regularly.

Despite limitations, including possible coding errors and claims data not reflecting a patient’s full medical and treatment history, this study provides an in-depth assessment of patients with newly diagnosed schizophrenia or schizoaffective disorder across three different payor types in the US. It highlights the high health burden of schizophrenia, suboptimal treatment practices, and often experienced relapses among these patients, indicating the need to improve patient treatment options and outcomes.

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