(269) Healthcare resource utilization and costs of schizophrenia among Medicaid beneficiaries

Background: : Schizophrenia, characterized by positive, cognitive, and negative symptoms, imposes significant healthcare resource utilization (HCRU) and cost burden on the US healthcare system, with Medicaid as the largest payer.

Objective: : With limited data on HCRU and costs of schizophrenia for Medicaid, this study evaluated HCRU and associated costs for this condition.

Methods: : This retrospective study utilized the Medicaid T-MSIS Analytic Files claims data (2021–2022). The study population included adults aged ≥18 years with at least 1-year continuous enrollment and two schizophrenia diagnoses. Two cohorts were analyzed: Medicaid patients (including fee-for-service (FFS) and managed care) for HCRU, and FFS-only subset for HCRU-related costs. HCRU outcomes included inpatient and outpatient visits—categorized by mental and non-mental health services—and ER visits. National and state-level costs (2022US$) were estimated.

Results: : This study included 143,970 Medicaid patients living with schizophrenia and 25,362 FFS-only patients. Over 12 months, nearly half (44.9%) had ≥1 inpatient admission, with an average length of stay (LOS) of 8.1 days. Outpatient visits (95.6%) and ER visits (91.6%) were common, averaging 38.2 and 9 visits annually, respectively. Mental health-related care accounted for a substantial portion of utilization: 68.8% of patients had ≥1 outpatient visit, and 24.6% had ≥1 mental health inpatient admission, with an average LOS of 5.2 days. Among FFS-only patients, the national average cost was $36,163 PPPY, with costs varying significantly across states. This is a minimum cost estimate due to the data not including Medicaid supplemental payments to hospitals.

Conclusions: : This study found significant burden of HCRU, and costs associated with schizophrenia among Medicaid beneficiaries. Limitations include potential misclassification due to absent diagnosis codes, the use of administrative claims data, and lack of generalizability beyond Medicaid enrollees. However, this study provides insights into key HCRU, and costs associated with schizophrenia among Medicaid beneficiaries, underscoring the importance of effective strategies to manage schizophrenia.

Sponsorship:: Boehringer Ingelheim Pharmaceuticals, Inc.