Pharmacotherapy Suboptimal After Schizophrenia Diagnosis in VHA System

A retrospective study aimed to investigate the impact of schizophrenia on United States veterans shortly after diagnosis indicated deficiencies in pharmacotherapy practices following diagnosis and underscored the substantial impact of the condition on veterans' hospitalization rates, health care resource utilization (HRU), and associated costs.

The investigation utilized a Veterans Health Administration (VHA) database to identify adults with a schizophrenia diagnosis between April 1, 2014, and December 31, 2017. These individuals were required to have no history of schizophrenia in the preceding 12 months and to be continuously enrolled in VHA for at least 12 months before and after the index date, which marked their first recorded schizophrenia diagnosis. The study assessed baseline characteristics and tracked subsequent treatment patterns, HRU, and costs.

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The study population comprised 20,389 patients, characterized by a significant baseline burden of mental health comorbidities. Notably, despite receiving a schizophrenia diagnosis, 32.1% of patients did not receive any antipsychotic medication during the follow-up period. Among those with at least one antipsychotic prescription, 64.0% were prescribed oral antipsychotic (OAP) therapy, while 11.6% received long-acting injectable (LAI) therapy. Both OAP and LAI therapies exhibited delays between diagnosis and treatment initiation, with averages of 39.0 ± 67.2 days and 69.4 ± 96.2 days, respectively. Adherence to therapy, defined as a proportion of days covered equal to or greater than 80%, was higher for LAIs (34.5%) compared to OAPs (27.3%).

During the 12-month follow-up period, 33.8% of patients experienced inpatient stays, with 5.5% of patients facing readmissions. The total cost of all-cause inpatient stays and related expenses over the 12-month period was estimated to be $7999 per patient annually.

Based on the findings, the study drew several conclusions. Firstly, the data highlighted suboptimal pharmacotherapy practices in the VHA system for veterans recently diagnosed with schizophrenia. A considerable proportion of patients did not receive any antipsychotic medication, indicating potential gaps in treatment. Additionally, there were delays in initiating both oral and long-acting injectable antipsychotic treatments after diagnosis. Moreover, veterans with schizophrenia experienced a significant burden in terms of hospitalization, other healthcare resource utilization, and associated health care costs.

These insights into the real-world scenario of schizophrenia management among veterans contribute to a better understanding of the health care landscape for this population.

Reference: 

Patel C, Huang A, Wang L, Paliwal Y, Joshi K. Patient Journey of Veterans with Schizophrenia: An Analysis of Treatment Patterns, Healthcare Resource Utilization and Costs. Adv Ther. 2022;39(3):1199-1214. doi:10.1007/s12325-021-01997-z