Prevalence, incidence and economic burden of schizophrenia among Medicaid beneficiaries

Objective: To estimate the prevalence, incidence and economic burden of schizophrenia among Medicaid beneficiaries.

Methods: Annual prevalence and incidence of schizophrenia among adult Medicaid beneficiaries were estimated during 2012-2017, by state and across six states (IA, KS, MS, MO, NJ and WI). The pooled estimate of the economic burden of schizophrenia was obtained during 1998Q1-2018Q1 across six states; adults with ≥2 diagnoses of schizophrenia were matched 1:1 to schizophrenia-free controls. The last observed schizophrenia diagnosis (schizophrenia cohort) or the last service claim (control cohort) with ≥12 months of continuous Medicaid enrollment before/after it defined the index date. Healthcare resource utilization (HRU) and costs ($2018 USD) incurred 12 months post-index were compared between cohorts. The economic burden of schizophrenia was also evaluated among young adults (18-34 years).

Results: Annual prevalence of schizophrenia ranged between 2.30% and 2.71% and annual incidence between 0.31% and 0.39% during 2012-2016. In 2017, only states with the highest incidence and prevalence rates (KS, MS, MO) had data, resulting in higher prevalence (4.01%) and incidence (0.52%). For the economic burden, adults with schizophrenia (N = 158,763) had higher HRU and incurred $14,087 higher healthcare costs versus controls (mean: $28,644 vs. $14,557), driven by $4677 higher long-term care costs (all p < .001). Young adults with schizophrenia incurred $14,945 higher healthcare costs versus controls, driven by $3473 higher inpatient costs (p < 0.001).

Conclusions: Annual prevalence and incidence of schizophrenia varied by state but remained stable over time. Adults with schizophrenia incurred greater HRU and costs relative to adults without schizophrenia; the burden appeared comparable among young adults.