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

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] Mental Illness Facts and Numbers. National Alliance on Mental Illness. 2015.http://namilacc.org/wp- content/uploads/2015/02/mentalillness_factsheet-1-1.pdf 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 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. 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. Hospital readmission statistics. HCUP National Inpatient Sample (NIS), Agency for Healthcare Research and Quality (AHRQ), 2014 Heslin K, Elixhauser A, Steiner C. Hospitalizations involving mental and substance use disorders among adults, 2012. HCUP Statistical Brief. 2015 Jun;191. Kaiser Family Foundation analysis of data from SAMHSA 2015 NSDUH (Accessed on July 27, 2017). 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. 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 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