Costs of New Atypical Antipsychotic Agents for Schizophrenia: Does Unrestricted Access Reduce Hospital Utilization?
Bibliographic record
Abstract
OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".