Prevalence, Incidence and Economic Burden of Schizophrenia Among Medicaid Beneficiaries

Background: Schizophrenia carries a substantial economic burden to healthcare systems and payers. This study aims to update the prevalence, incidence and economic burden of schizophrenia among Medicaid beneficiaries.

Methods: Medicaid data from IA, KS, MS, MO, NJ, and WI was used. Prevalence and incidence of schizophrenia among adults were estimated during 2012-2017. For the economic burden analysis, adults with ≥2 schizophrenia diagnoses and schizophrenia-free controls were selected during Q1/1998-Q1/2018. The index date for each cohort was the last observed schizophrenia diagnosis (schizophrenia cohort) or the last service claim (control cohort) with ≥12 months of continuous Medicaid enrollment before and after. Economic outcomes were compared during the 12-month post-index period between matched cohorts.

Results: Prevalence of schizophrenia ranged between 2.16%-4.01% and incidence between 0.31%-0.52% during 2012-2017. Economic burden of 158,763 schizophrenia patients (mean age 50.5 years, 49.0% female, 49.0% with antipsychotic use) and matched controls were compared. Schizophrenia patients had 74% more inpatient stays, 79% more emergency room visits, 51% more outpatient visits, 92% more long-term care stays, 5 times more mental-health institute visits, and 15.8 times more mental-health institute stay days (all p<0.001) than controls. Schizophrenia patients, relative to controls, incurred incremental total healthcare costs of $14,087 (mean: $28,644 vs $14,557), driven by long-term care ($4,677), inpatient ($2,044), mental-health institute ($1,990) stay costs, and pharmacy costs ($1,836; all p<0.001).

Conclusions: In this 6-state Medicaid study, prevalence of schizophrenia ranged between 2.16%-4.01% and the incidence between 0.31%-0.52% during 2012-2017. Moreover, schizophrenia was associated with greater Medicaid spending relative to schizophrenia-free controls.

This poster was presented at the 32nd annual Psych Congress, held Oct. 3-6, 2019, in San Diego, California.