Understanding healthcare burden and treatment patterns among young adults with schizophrenia

Background: Schizophrenia is a serious public health problem that affects ∼1% of the US population. Aims: To examine treatment patterns and evaluate healthcare resource utilization (HRU) and costs among young adults (18–35 years) with schizophrenia who were early in the disease. Materials and methods: Patients aged 18–64 years with ≥2 schizophrenia diagnoses in the identification period (January 1, 2012–September 30, 2015) and continuous enrollment for ≥12 months pre- and post-index date were identified from the OptumInsight Clinformatics DataMart. Demographics, clinical characteristics, HRU, costs, and treatment patterns were compared between schizophrenia and non-schizophrenia “controls” cohorts and between young (18–35 years) and older adults (36–64 years) with schizophrenia. Results: Among 9,889 schizophrenia patients, 23.70% were young adults (aged 18–35), had higher all-cause per-patient-per-year (PPPY) costs ($22,338 vs $7,332; p <.0001), higher inpatient costs ($8,857 vs $1,289; p <.0001), and longer inpatient length-of-stay (LOS) (5.0 vs 0.4 days, p <.0001; adjusted incidence rate ratio [aIRR] = 12.8; 95% confidence interval [CI] = 11.5–14.3) than controls. Among young adults with schizophrenia, there were more mental-health-related and fewer non-mental-health-related diagnoses compared to older adults with schizophrenia; 63.40% were male. Young adults with schizophrenia incurred higher inpatient costs ($15,692 vs $10,274; p <.0001) and longer inpatient LOS (9.6 vs 5.9 days, p <.0001; aIRR = 1.6; 95% CI = 1.4–1.8) compared to older adults with schizophrenia. A substantial proportion of patients were treated with oral antipsychotics vs long-acting injectables in both cohorts (young adults: 98.72% vs 9.71%; older adults: 98.10% vs 13.31%). Limitations: Claims data are collected for payment and not research. The presence of a prescription claim does not indicate medication was consumed or taken as prescribed. Conclusions: The economic burden for schizophrenia patients is substantial, especially among young adults. Based on this analysis, further research is warranted to better understand the association between adherent treatment patterns earlier in the disease and long-term health outcomes among patients with schizophrenia.