COST CONTROL MODEL ON INPATIENT MEDICATION AMONG ADULTS WITH MENTAL AND BEHAVIORAL HEALTH DISORDER

Authors

Huanan Li, University of the PacificFollow
William A. Kehoe, University of the PacificFollow
Joseph A. Woelfel, University of the PacificFollow
Patrick N. Catania, University of the PacificFollow
Eric Boyce, University of the PacificFollow
Michelle M. Amaral, University of the PacificFollow
Jacquelyn Cituk, St.Josep's Medical CenterFollow

Poster Number

5a

Lead Author Affiliation

Health Care Outcomes and Clinical Services

Lead Author Status

Doctoral Student

Second Author Affiliation

Pharmacy Practice

Second Author Status

Faculty

Third Author Affiliation

Pharmacy Practice

Third Author Status

Faculty

Fourth Author Affiliation

Pharmacy Practice

Fourth Author Status

Faculty

Fifth Author Affiliation

Pharmacy Practice

Fifth Author Status

Faculty

Sixth Author Affiliation

Economics

Sixth Author Status

Faculty

Additional Authors

Jacquelyn Cituk, PharmD. St.Josep's Medical Center Jacquelyn.Cituk@DignityHealth.org

Introduction/Abstract

By 2016, approximately 20% of American adults (44.7 million) experience some form of mental illness (MI) while 6% of Americans (13.6 million) live with a serious mental illness (SMI), such as major depression, schizophrenia, or bipolar disorder.[1]^,[2] Co-morbidity (mental and physical conditions both exist) can reduce quality of life, cause worse health outcomes and longer disease duration. Due to the loss of work efficiency and the increase in the use of healthcare services, co-morbidity can also create an economic burden for society.[3] Over the past half century, the annual healthcare expenditure increased from $146 per person in 1960 to $10,348 per person in 2016.[4] Among U.S. hospitals, about 13% of mental disorder discharges are readmitted for the same type diagnosis within a span of 30 days.[5] 8.6 million inpatient stays were found to be involved with at least one mental disorder or substance use disorder (SUDs) diagnosis, accounting for 32.3% of the total inpatient stays.[6] In 2015, with any mental illness among adults, 43% received mental health treatment and 65% of adults with serious mental illness received treatment.[7] However, only 32.9% of adults received mental health treatment between 2001 and 2003.[8] The drug expenditure signifies an important part of the entire hospital operating budget and inpatient pharmaceuticals represent one of the highest costs in hospitals.[9] Beyond that, the rise in expenditures on inpatient drugs exceeds the increase in expenditures on outpatient drugs.[10]

1. Mental Illness Facts and Numbers. National Alliance on Mental Illness. 2015.http://namilacc.org/wp- content/uploads/2015/02/mentalillness_factsheet-1-1.pdf
2. Any Mental Illness (AMI) Among Adults. Last Updated: November 2017. http://www.nimh.nih.gov/health/statistics/prevalence/any-mental-illness-ami-among-adults.shtml
3. Blackwell DL, Lucas JW, Clarke TC. Summary health statistics for US adults: national health interview survey, 2012. Vital and health statistics. Series 10, Data from the National Health Survey. 2014 Feb(260):1-61.
4. Catlin AC, Cowan CA. History of health spending in the United States, 1960-2013. Baltimore, MD: Centers for Medicare and Medicaid Services. 2015 Nov 19.
5. Hospital readmission statistics. HCUP National Inpatient Sample (NIS), Agency for Healthcare Research and Quality (AHRQ), 2014
6. Heslin K, Elixhauser A, Steiner C. Hospitalizations involving mental and substance use disorders among adults, 2012. HCUP Statistical Brief. 2015 Jun;191.
7. Kaiser Family Foundation analysis of data from SAMHSA 2015 NSDUH (Accessed on July 27, 2017).
8. Kessler RC, Demler O, Frank RG, Olfson M, Pincus HA, Walters EE, Wang P, Wells KB, Zaslavsky AM. Prevalence and treatment of mental disorders, 1990 to 2003. New England Journal of Medicine. 2005 Jun 16;352(24):2515-23.
9. Moore TJ, Mattison DR. Adult Utilization of Psychiatric Drugs and Differences by Sex, Age, and Race. JAMA Intern Med. 2017;177(2):274–275. doi:10.1001/jamainternmed.2016.7507
10. Final report: Trends in Hospital Inpatient Drug Costs: Issues and Challenges. http://www.aha.org/content/16/aha-fah-rx-report.pdf. October 11, 2016.

Purpose

1. Examine mental and behavioral health disorder medications and the primary chronic disease medications associated with mental and behavioral health disorders that demand strict formulary management control. This will be done using an ABC-VEN matrix analysis on a sample obtained from an acute psychiatric hospital. We plan to identify any statistically significant difference in medication cost among nine subgroup categories under ABC-VEN matrix analysis.
2. We will also predict the leading drivers associated with the growing inpatient hospital medication costs among patients admitted to a mental and behavioral health disorder hospital by using statistical modeling.

Method

1. ABC analysis, VEN analysis, and ABC-VEN matrix analysis will be conducted in order to identify the medications that require strict pharmacy cost control. The list of medication items used in the pharmacy will be categorized in accordance with the American Hospital Formulary Services (AHFS). Consumption and expenditure data incurred for each medication item in the behavioral health center for a 4-month period will be collected from the medication purchase invoices. The cumulative expenditure incurred for each medication will be calculated for a 4-month period. For each hospitalization, a patient medication profile will be created and saved.
2. Under this sub-study, we will use patient socio-demographic factors (gender, age), clinical factors (Length of Stay, Major Diagnosis Category (MDC), and Diagnosis Related Groups(DRGs)) as independent variables to identify the main drivers associated with the inpatient cost in acute psychiatric hospital pharmacy. ICD-10 code will be used to code the DRGs using information on patients with Medicare to impute the DRGs for patients without Medicare. An analysis of cost will be generated by applying a regression model. Length of Stay (LOS) will also be analyzed using a Poisson model. We will be testing if length of stay (LOS) is a proxy for hospital medication cost per patient. All statistical tests were conducted using Stata 15.0 (Stata Statistical Software, Stata Corp, LLC, College Station, TX).

Results

1. It is expected that the majority (70-80 percent) of inpatient pharmaceutical costs among patients with mental and behavioral disorders in an acute psychiatric hospital are caused by expensive medications (high-cost drugs) or vital medications (high volume drugs), and there will be significant differences in medications costs among nine subgroup categories.
2. Patients with longer hospital stays, higher cost/volume Medications, or co-morbidities are more likely to be associated with the growing inpatient pharmaceutical cost in an acute psychiatric hospital.

Significance

This will be the first study that measures and examines both the inpatient medications usage pattern and costs including the medications prescribed for the treatment of mental and behavioral disorders and the treatment of chronic diseases in acute psychiatric hospital. This is also among the first studies to seek if there is statistically significant difference among nine subgroup categories under ABC-VEN matrix analysis. Moreover, as a result of this research, the executives of an acute psychiatric hospital will be able to identify the most important factors associated with high inpatient medication costs by applying the cost prediction model. Therefore, the hospital pharmacy budget could be determined based on a scientifically based approach.

Location

DeRosa University Center

Format

Poster Presentation

Poster Session

Afternoon 1pm-3pm