By Annette M. Boyle
TEMPLE, TX – While taking antipsychotic medication often benefits patients, evidence increasingly challenges the assumption that more is better, even as the rate of prescriptions for multiple antipsychotics continues to rise in the VA and other health systems.
Nationwide, the direct and indirect costs of schizophrenia run about $63 billion per year or $26,000 to $31,000 per patient. While schizophrenia affects approximately 1 in 100 Americans, schizophrenic patients account for 25% of the country’s mental health costs and hospital bed days each year. Within the VA, 4% of veterans in care have a diagnosis of schizophrenia, but they occupy more hospital beds than veterans with any other illness. Among active duty personnel, the incidence rate is 0.14 per 1,000 person-years.
Both hospitalization and polypharmacy rates typically indicate issues in disease management and have significant impact on overall cost of care. Researchers at the Center for Applied Health Research in Temple, TX, recently reviewed pharmacologic treatment patterns for schizophrenia across several healthcare settings in a study published recently in the American Journal of Health-system Pharmacists. They found that “in all samples evaluated, polypharmacy was associated with an increased likelihood of hospital admission.” 1
The researchers looked at drug utilization records for 119,662 patients in the VA system during the 2005 to 2009 time period, 5,440 patients enrolled in two health maintenance organizations (HMOs), and data from the National Ambulatory Medical Care Survey (NAMCS) for 17.6 million residents of the United States who sought treatment outside of federal systems between 2002 and 2009.
They found that about three-quarters of schizophrenic veterans are prescribed antipsychotics, in keeping with clinical guidelines recommending ongoing monotherapy with an antipsychotic for treatment of schizophrenia. In the two health maintenance organizations studied, by contrast, antipsychotic prescription rates ranged from 22% to 67%. The NAMCS rates ranged from 69% to 84%. The rates of prescriptions for multiple antipsychotics showed a similarly wide variance, from about 20% in the VA to 19% to 31% in the HMO and NMACS samples.
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