Richard Wyatt, M.D., chief of neuropsychiatry, National
Institutes of Mental Health, said today at a news conference at the
American Psychiatric Association annual meeting here that nearly 30
percent ($19 billion) of schizophrenia's cost involves direct treatment
and the rest is absorbed by other factors -- lost time from work for
patients and care givers, social services and criminal justice resources.
Wyatt said schizophrenia affects one percent of the population,
accounts for a fourth of all mental health costs and takes up one in three
psychiatric hospital beds. Since most schizophrenia patients are never
able to work, they must be supported for life by Medicaid and other forms
of public assistance.
"The debilitating nature of the illness brings enormous family
and societal costs that often go unnoticed because they're not reported to
health insurers or mental health agencies," said Wyatt.
Greater utilization of outpatient care is occurring widely as
states seek to hold the line on mental health costs by closing or
downsizing psychiatric hospitals. But according to William Glazer, M.D.,
assistant clinical professor of psychiatry at Yale University, the
substantial medical and non-medical costs associated with schizophrenia
will persist unless discharged patients are given new medications that
enable them to function normally in society.
"Older antipsychotics commonly used in state hospitals and
continued upon discharge cause an alarmingly high rate of permanent, often
irreversible, involuntary movements called tardive dyskinesia," Glazer
said. "This side effect can be crippling and causes many patients to
discontinue therapy and eventually relapse."
Wyatt and Glazer believe providing wider access to a new but
expensive class of antipsychotic drugs, known as "atypical"
antipsychotics, will significantly reduce hospitalizations for
schizophrenia patients and enable them to avoid relapse and lead
"Newer antipsychotics generally are tolerated much better than
the older drugs," Glazer said. "As a result, patients are more likely to
stay on therapy and stay out of the hospital." Wyatt believes improving
compliance would lessen some of the financial burden of schizophrenia.
"Even though the newer agents are considerably more expensive, their
downstream cost benefits justify more widespread use," he said. "For
example, in large state or V.A. hospitals, it might be possible to close
one psychiatric unit or ward as the inpatient population decreases."
Despite these cost benefits, the older medications still
constitute about 85 percent of prescriptions written for antipsychotic
drugs. "Clearly, an educational effort is needed to convince Medicaid
officials, state legislators and other policy makers to permit greater
access to state-of-the-art drug therapy for schizophrenia," Glazer said.
Some progress has been made, however, New York Governor George
Pataki recently struck down a state regulation that restricted access to
one atypical antipsychotic drug, citing the cost benefits it provides by
allowing long-term inpatients to be returned to their communities.
"This new policy is a winner for the people of New York because
it will help people with schizophrenia live a more normal life and provide
relief to our taxpayers," Pataki said in a statement released on March 12.
Wyatt and Glazer say they are encouraged by this action and urge
more states to grant wider access to new antipsychotics.
CO: American Psychiatric Association
ST: New York