Assessing the Economic Burden and Health Care Utilizations of U.S. Veteran Patients with Schizophrenia

Objective: To examine the economic burden and health care utilizations of schizophrenia in the U.S. veteran population. Methods: A retrospective database analysis was performed using the Veterans Health Administration (VHA) Medical SAS® datasets from October 1, 2008 through September 30, 2012. Patients diagnosed with schizophrenia were identified, and the initial diagnosis date was designated as the index date. A group of patients without schizophrenia of the same age, region, gender and index year were identified and matched by baseline Charlson Comorbidity Index (CCI) score, as the comparison group. Patients in both groups were required to be at least age 18 years and have continuous medical and pharmacy benefits 1 year pre- and 1 year post-index date. One-to-one propensity score matching was used to compare health care costs and utilizations during the follow-up period between the schizophrenia and comparison group patients, adjusted for baseline demographic and clinical characteristics. Results: A total of 171,086 eligible patients were identified for the schizophrenia and control cohorts. After 1:1 matching, a total of 70,045 patients were matched from each cohort with well-balanced baseline characteristics. Patients diagnosed with schizophrenia had significantly higher health care utilization in inpatient (18.12% vs. 2.30%, p<0.01), emergency room (19.67% vs. 6.46%, p<0.01), office (98.32% vs. 53.26%, p<0.01), and outpatient visits (98.53% vs. 54.16%, p<0.01). Higher health care utilizations translated into higher costs for schizophrenic patients including inpatient ($7,228 vs. $613, p<0.01), pharmacy ($1,012 vs. $343, p<0.01), outpatient ($3,998 vs. $1,302, p<0.01), and total costs ($12,238 vs. $2,260, p<0.01) relative to patients in the comparison group. Conclusion: Patients diagnosed with schizophrenia in the U.S. VHA system were associated with a substantial economic burden, compared to their matched controls.