Costs of new atypical antipsychotic agents for schizophrenia: does unrestricted access reduce hospital utilization?

To determine whether increased expenditures to provide unrestricted access to expensive atypical antipsychotic drugs would be associated with a reduction in hospital utilization and cost by patients with schizophrenia. Secondary objectives were to determine the factors associated with length of stay (LOS) and readmission for schizophrenia sufferers.

Retrospective chart review identified all acute hospitalizations for schizophrenia in the province of Newfoundland and Labrador. LOS and readmission rates, as well as risk factors influencing them, were measured during three time periods: (1) 1995/96, beginning of restricted access; (2) 1998, last year of restricted access; and (3) 2000, second year of open access. Average per diem costs were multiplied by LOS to determine hospital expenditures, and the provincial drug plan database provided the amount of money reimbursed for antipsychotic drugs.

Days of hospitalization for schizophrenia totalled 15,089 in 1995/96, 16,318 in 1998 and 15,691 in 2000, resulting in per annum costs of $6,474,095, $7,080,065 and $6,615,795, respectively. There were 57 (18.2%) fewer patients hospitalized and 98 (16.7%) fewer admissions during open access (2000) when compared to a period of restricted access (1995/96). However, median LOS in 2000 was significantly longer than in 1995/96 (22.0 vs. 15.0 days, P<0.001), and was independent of other factors significantly associated with LOS (e.g., suicidal ideation on admission). No change in the number of readmissions was observed. Government expenditures for atypical agents were $217,273 in 1995/96 and $3.8 million in 2000, a 17.5-fold increase.

The unrestricted reimbursement policy for atypical antipsychotics was associated with a large increase in drug plan expenditure, which was not offset by a decrease in hospital utilization by schizophrenia sufferers. Although a decrease in hospital admissions occurred, any associated savings were negated by an increase in LOS.