State- and County-Level Antipsychotic Utilization, Healthcare Resource Use and Costs, and Quality of Care among Medicare Beneficiaries with Schizophrenia in the United States

Abstract: Objective: To examine the regional variation in schizophrenia care, as measured by antipsychotic (AP) utilization, healthcare resource utilization (HRU) and associated costs, and quality measures, among US Medicare beneficiaries. Method: The sample included all adult Medicare beneficiaries with continuous fee-for-service Medicare Parts A, B, and D coverage and ≥1 inpatient and/or ≥2 outpatient claims with a diagnosis for schizophrenia in the 2019 100% Medicare files. Summary statistics on AP use; HRU, costs, and quality measures were reported at the state and county levels. Study results will be displayed via the Schizophrenia Ecosystem Tool (SET), an interactive map-based resource to visualize metrics individually and in combination for some measures. Result: The percentage of beneficiaries with schizophrenia who filled >1 antipsychotic in 2019 was highest in Minnesota (94%) and lowest in Washington, DC (84%). The county-level variation was larger ranging from 65% to 100%. Large state-level variations were found in long-acting injectable antipsychotic (LAI) use (14% [MA] to 33% [AZ]), all-cause hospitalizations (22% [ID] to 36% [LA]), all-cause emergency room visits (41% [ND] to 55% [WY]), all-cause total costs ($17,216[NM] to $27,647[CA]), and 30-day hospital readmissions (19% [HI] to 34% [FL]). Discussion: This study is the first to provide state- and county-level metrics of antipsychotic underutilization, economic burden, and quality of care among US Medicare beneficiaries with schizophrenia. The interactive map-based resource allows for visualization of regional inequities, thus supporting targeted improvement initiatives by state and local policy makers and mental health providers.Short Description: This study used 2019 national Medicare claims data for all fee-for-service beneficiaries with schizophrenia in the United States to describe their antipsychotic utilization, healthcare resource use, costs, and quality of care at the state and county levels. The results highlight large regional variations in antipsychotic underutilization, economic burden, and quality of care for patients with schizophrenia and provide important insights for state and local policy makers and mental health providers.Name of Sponsoring Organization(s): Janssen Scientific Affairs, LLC.