2023 14th Annual NUBE Conference

Objective: Episodes of acute agitation associated with schizophrenia (SCZ) or bipolar disorder (BPD) pose treatment and economic challenges for patients and staff. Occurrence of staff injuries, physical restraint use, extended inpatient admissions, and increased emergency department (ED) boarding create a complex clinical environment. Identifying and quantifying the impact of these treatment challenges and economic drivers is critical to effective patient management strategies.Methods: Two separate analyses of medical and pharmacy claims data [Clarivate Real World Data between 9/2015 and 4/2022 and Healthcare Cost and Utilization Project (HCUP) Nationwide Emergency Department Sample (NEDS) from 2018] quantified prevalence and direct medical costs from ED and inpatient visits. These data were combined with a multicenter retrospective chart review and published data to provide a comprehensive overview of the clinical and economic burden of acute agitation episodes in patients with SCZ and BPD.

Results: Within this population, high utilizers of healthcare resources comprise 12% of patients but account for 54% of agitation episodes. This subset of high-utilizing patients had 5 times the mortality risk and nearly double the 30-day hospital readmission rate (65% vs 37%) versus the lower-utilizing group.When treated in the ED, 27% of patients with agitation associated with SCZ or BPD were physically restrained contributing to additional direct medical costs of $1,511 (SCZ) and $1,233 (BPD). Components of these additional costs of physically restraining patients in the ED included 4.2 additional hours in the ED, 8% higher inpatient admission rate, 1.45 days longer inpatient stays, and 22% staff injury incidence. Total inpatient admission costs were $11,000 (SCZ) and $7,600 (BPD). Hospital staff injury Workman's Compensation claims were an average of $15,860 between 2006 and 2011. Additional challenges around ED patient boarding cost $ 3,400 and denied care of 2.2 patients.

Conclusion: Treatment of agitation associated with SCZ and BPD is challenging and results in higher healthcare utilization and higher patient mortality risk. Direct medical costs are increased from ED and inpatient admission incidence rates and length of stays, increased patient physical restraint use, increased staff injuries, and ED boarding. Detailing and quantifying these clinical and economic patient treatment challenges can assist in evaluating the current therapeutic paradigms and selecting effective and safe treatment options which may improve patient outcomes and lower staff burden.