Stephen Boccuzzi

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Schizophrenia is a chronic disease associated with significant direct and indirect healthcare costs. Nonadherence to antipsychotic treatment has emerged as a significant contributing cost factor due to its direct association with clinical relapse.  

Poorly adherent patients with schizophrenia are 2.4 times more likely to be admitted to hospital than patients with good adherence. Conversely, Medicaid inpatient cost reductions for improved adherence to antipsychotic therapy have been estimated at more than $100 million.  

Treatment adherence, relapse, rehospitalization and associated healthcare costs differ among various antipsychotic pharmacologic agents and formulations (oral compared with depot antipsychotics). Use of (slow-release) depot antipsychotics has been associated with increased adherence, reduced hospitalization and decreased healthcare costs compared with oral agents. One antipsychotic therapy switching study (oral to depot agents) reported a 50% decline in psychiatric hospitalizations, two days shorter mean hospitalization stay, and a 30% reduction in total costs. Despite this evidence, depot antipsychotics continue to be underutilized and are still mainly perceived as a "last resort" for nonadherent patients.  

A team approach to care coordination, including decision support for best practices, and personalized patient support will be key to realizing value in various treatment alternatives. Moreover, innovative approaches to individually tailored medication regimens will be needed to address the multiple determinants that contribute to nonadherence. In 2009, expert consensus guidelines supported such a multifaceted approach to address the multiple barriers to patient adherence. 

Better evidence-based approaches for identification and risk stratification of appropriate patients will be key, particularly for early-stage or newly diagnosed patients. 

In summary, nonadherence to antipsychotic medications and the management of patients with schizophrenia account for significant costs for the healthcare system. Nonadherence is critically relevant to all stakeholders in the management of schizophrenia, including payers, formulary decision makers, administrators, healthcare practitioners, patients and their families. This challenging condition will require not only new and better tolerated antipsychotic agents, but more individualized treatment approaches. 

 is vice president, Health Economics & Outcomes Research and Field Medical Strategy for Otsuka America Pharmaceutical, Inc. 

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