The introduction of an unrestricted reimbursement policy for atypical antipsychotic medications in Newfoundland and Labrador: the impact on hospital utilization by patients with schizophrenia

O'Reilly, Daria Joan (2005) The introduction of an unrestricted reimbursement policy for atypical antipsychotic medications in Newfoundland and Labrador: the impact on hospital utilization by patients with schizophrenia. Doctoral (PhD) thesis, Memorial University of Newfoundland.

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Abstract

Objectives: To measure total days of hospitalization, length of stay (LOS) and readmission risk for patients with schizophrenia following the introduction of an unrestricted reimbursement policy for costly atypical antipsychotic medications. -- Methods: A province-wide, observational, retrospective hospital chart review, using a before and after design, was used to identify all hospital admissions and quantify data on risk factors associated with LOS and readmission for acute episodes of schizophrenia. Three time periods were studied: 1) 1995/96 at the beginning of restricted access to atypical agents; 2) 1998 at the last year of restricted access; and 3) 2000 the second year of open access. Multivariable Cox proportional hazards and logistic regression models were used to identify risk factors influencing LOS and readmission within one year of discharge respectively. Retrospective administrative prescription claims provided data on the use of and expenditure for atypical agents before and after the policy change. -- Results: Total days hospitalization for schizophrenia in 1995/96 was 15,089, 16,318 in 1998 and 15,691 in 2000. There were 57 (18.2%) fewer patients admitted to hospital and 98 (16.7%) fewer admissions during the period of open access (2000) when compared to baseline (1995/96). However, median LOS in 2000 was significantly longer than in 1995/96 (22.0 vs. 15.0 days, P<0.001). Being admitted in 2000 compared to baseline was a significant predictor of increased LOS (HR: 3.04, CI=1.57-5.86, P=0.0009); independent of requiring ECT (HR: 2.49, CI=1.69-3.66, P<0/001); seclusion (HR: 1.87, CI=1.41-2.50, P<0.001); thought disorder (HR: 1.41, CI=1.11-1.81, P=0.006); suicidal ideation on admission (HR: 0.70, CI=0.57-0.86, P=0.0007) and discharging against medical advice (HR: 0.38; CI=0.27-0.54, P<0.001). No change m the number of readmissions was observed over the study period. -- Expenditures for atypical agents were $217,273 in 1995/96, $1.3 million in 1998, and 3.8 million in 2000, a 17.5 fold increase. -- Conclusions: The unrestricted reimbursement policy for atypical antipsychotic medications was associated with a large increase in government expenditure for these drugs, which was not associated with a decrease in hospital utilization in the province by schizophrenia sufferers. Although a decrease in hospital admissions occurred, this was negated by an increase in LOS.

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