Community Mental Health Journal

, Volume 49, Issue 6, pp 625–629 | Cite as

Impact of Oral Antipsychotic Medication Adherence on Healthcare Resource Utilization Among Schizophrenia Patients with Medicare Coverage

  • Steve Offord
  • Jay Lin
  • Bruce Wong
  • Dario Mirski
  • Ross A. Baker
Brief Report


Nonadherence to antipsychotic medications is widespread and compromises the outcome of patients with schizophrenia. Using the MarketScan Medicare claims database, this study examined the impact of medication adherence on healthcare utilization among Medicare insured schizophrenia patients. The study population was separated into two cohorts defined by medication adherence, one with a medication possession ratio (MPR) ≥0.7 (high adherence) and the other with a MPR <0.7(low adherence). Of the 354 patients identified, 126 (36 %) had high adherence (mean ± SD MPR 0.94 ± 0.09) and 228 (64 %) had low adherence (MPR 0.24 ± 0.19). All cause hospitalizations (0.68 vs. 0.44; p = 0.015) and length of stay (LOS) (7.0 vs. 2.6 days; p = 0.005), and relapse hospitalizations (0.22 vs. 0.11; p = 0.028) and LOS (3.2 vs. 0.7 days; p = 0.027) were greater among patients with low adherence. Low adherent Medicare insured patients with schizophrenia require significantly more inpatient care and represent a patient population in which effective interventions are needed to improve disease management.


Schizophrenia Adherence Healthcare utilization Costs 



This research and development of this manuscript was supported by Otsuka America Pharmaceutical, Inc. and H. Lundbeck A/S.

Conflict of interest

Steve Offord and Dario Mirski are employees of Otsuka America Pharmaceutical, Inc. Jay Lin is an employee of Novosys Health, which has received research funds from Otsuka America Pharmaceutical, Inc. in connection with conducting this study and development of this manuscript. Bruce Wong is a paid consultant for Otsuka America Pharmaceutical, Inc. in connection with conducting this study and development of this manuscript. Ross Baker is an employee of Otsuka Pharmaceutical Development and Commercialization, Inc.


  1. Ascher-Svanum, H., Zhu, B., Faries, D. E., Salkever, D., Slade, E. P., Peng, X., et al. (2010). The cost of relapse and the predictors of relapse in the treatment of schizophrenia. BMC Psychiatry, 10, 2. doi: 10.1186/1471-244X-10-2.PubMedCrossRefGoogle Scholar
  2. Carlborg, A., Winnerbäck, K., Jönsson, E. G., Jokinen, J., & Nordström, P. (2010). Suicide in schizophrenia. Expert Review of Neurotherapeutics, 10(7), 1153–1164.PubMedCrossRefGoogle Scholar
  3. Fors, B. M., Isacson, D., Bingefors, K., & Widerlöv, B. (2007). Mortality among persons with schizophrenia in Sweden: An epidemiological study. Nordic Journal of Psychiatry, 61(4), 252–259.PubMedCrossRefGoogle Scholar
  4. Horvitz-Lennon, M., Donohue, J. M., Domino, M. E., & Normand, S.-L. T. (2009). Improving quality and diffusing best practices: The case of schizophrenia. Health Affairs, 28(3), 701–712.PubMedCrossRefGoogle Scholar
  5. Howard, R., Rabins, P. V., Seeman, M. V., & Jeste, D. V. (2000). Late-onset schizophrenia and very-late-onset schizophrenia-like psychosis: An international consensus. The International Late-Onset Schizophrenia Group. The American Journal of Psychiatry, 157(2), 172–178.PubMedCrossRefGoogle Scholar
  6. Kane, J. M. (2007). Treatment adherence and long-term outcomes. CNS Spectrums, 12(10 Suppl 17), 21–26.PubMedGoogle Scholar
  7. Kelin, K., Lambert, T., Brnabic, A. J., Newton, R., Ye, W., Escamilla, R. I., et al. (2011). Treatment discontinuation and clinical outcomes in the 1-year naturalistic treatment of patients with schizophrenia at risk of treatment nonadherence. Patient Preference and Adherence, 5, 213–222.PubMedCrossRefGoogle Scholar
  8. Khaykin, E., Eaton, W. W., Ford, D. E., Anthony, C. B., & Daumit, G. L. (2010). Health insurance coverage among persons with schizophrenia in the United States. Psychiatric Services, 61(8), 830–834.PubMedCrossRefGoogle Scholar
  9. Kirkpatrick, B., Messias, E., Harvey, P. D., Fernandez-Egea, E., & Bowie, C. R. (2008). Is schizophrenia a syndrome of accelerated aging? Schizophrenia Bulletin, 34(6), 1024–1032.PubMedCrossRefGoogle Scholar
  10. Lindenmayer, J.-P., Liu-Seifert, H., Kulkarni, P. M., Kinon, B. J., Stauffer, V., Edwards, S. E., et al. (2009). Medication nonadherence and treatment outcome in patients with schizophrenia or schizoaffective disorder with suboptimal prior response. The Journal of Clinical Psychiatry, 70(7), 990–996.PubMedCrossRefGoogle Scholar
  11. Llorca, P.-M. (2008). Partial compliance in schizophrenia and the impact on patient outcomes. Psychiatry Research, 161(2), 235–247.PubMedCrossRefGoogle Scholar
  12. Marcus, S. C., & Olfson, M. (2008). Outpatient antipsychotic treatment and inpatient costs of schizophrenia. Schizophrenia Bulletin, 34(1), 173–180.PubMedCrossRefGoogle Scholar
  13. McFarland, B. H., & Collins, J. C. (2011). Medicaid cutbacks and state psychiatric hospitalization of patients with schizophrenia. Psychiatric Services, 62(8), 871–877.PubMedCrossRefGoogle Scholar
  14. Meesters, P. D., de Haan, L., Comijs, H. C., Stek, M. L., Smeets-Janssen, M. M. J., Weeda, M. R., et al. (2012). Schizophrenia spectrum disorders in later life: Prevalence and distribution of age at onset and sex in a dutch catchment area. The American Journal of Geriatric Psychiatry, 20(1), 18–28.PubMedCrossRefGoogle Scholar
  15. Stephenson, J. J., Tuncelli, O., Gu, T., Eisenberg, D., Panish, J., Crivera, C., et al. (2012). Adherence to oral second-generation antipsychotic medications in patients with schizophrenia and bipolar disorder: physicians’ perceptions of adherence vs. pharmacy claims. International Journal of Clinical Practice, 66(6), 565–573.PubMedCrossRefGoogle Scholar
  16. US Census Bureau. (2011). US census bureau newsroom: 2010 Census: 2010 census shows 65 and older population growing faster than total U.S. population. Retrieved from
  17. Valenstein, M., Copeland, L. A., Owen, R., Blow, F. C., & Visnic, S. (2001). Adherence assessments and the use of depot antipsychotics in patients with schizophrenia. The Journal of Clinical Psychiatry, 62(7), 545–551.PubMedCrossRefGoogle Scholar
  18. Weiden, P. J., & Olfson, M. (1995). Cost of relapse in schizophrenia. Schizophrenia Bulletin, 21(3), 419–429.PubMedCrossRefGoogle Scholar
  19. West, J. C., Wilk, J. E., Olfson, M., Rae, D. S., Marcus, S., Narrow, W. E., et al. (2005). Patterns and quality of treatment for patients with schizophrenia in routine psychiatric practice. Psychiatric Services, 56(3), 283–291.PubMedCrossRefGoogle Scholar
  20. Wu, E. Q., Birnbaum, H. G., Shi, L., Ball, D. E., Kessler, R. C., Moulis, M., et al. (2005). The economic burden of schizophrenia in the United States in 2002. The Journal of Clinical Psychiatry, 66(9), 1122–1129.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Steve Offord
    • 1
  • Jay Lin
    • 2
  • Bruce Wong
    • 3
  • Dario Mirski
    • 1
  • Ross A. Baker
    • 4
  1. 1.Otsuka America Pharmaceutical, Inc.PrincetonUSA
  2. 2.Novosys HealthFlemingtonUSA
  3. 3.University of PennsylvaniaPhiladelphiaUSA
  4. 4.Otsuka Pharmaceutical Development and Commercialization, Inc.PrincetonUSA

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