Background: Schizophrenia (SCZ) is associated with significant economic burden, but little is known about the economic impact of treatment-resistant schizophrenia (TRS).
Objectives: To estimate the economic outcomes associated with Medicaid beneficiaries with TRS compared to those with SCZ but not TRS.
Methods: 2008-2012 patient-level Medicaid data from 43 states and DC were used for analysis. Ambulatory Medicaid beneficiaries with SCZ (ICD-9-CM codes 295.00-295.99) were required to have continuous Medicaid enrollment throughout the study period; index date - date of first claim for initial antipsychotic (AP); no AP claims 6 months prior to index date; and at least 12 months after index with ≥1 claim for an AP. Cohorts for comparison were those with TRS (≥3 claims for APs from at least two different chemical classes with ≤30-day gaps between them) and those with SCZ but not TRS. The a priori level of statistical significance for all tests was set at P<0.05. Economic results reflect 2012 US dollars.
Results: Of the 296,417 patients with SCZ in the 5-year period, 107,852 met inclusion/exclusion criteria. 31% of these treated SCZ patients had TRS (33,434/107,852). For TRS, physician service expenditures increased by $358/person/year (P<0.05; 14% differential); hospital/laboratory increased by $890 (P<0.05; 26% differential); pharmacotherapy increased by $648 (P<0.05; 11% differential); and total SCZ-related health service expenditures increased by $1,896/person/year (P<0.05; 19% differential), relative to those with SCZ, but not TRS.
Conclusions: TRS is exhibited by a large proportion of Medicaid beneficiaries with SCZ, and is associated with an increase in SCZ-related expenditures.