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The British Journal of Psychiatry (2004) 184: 509-516
© 2004 The Royal College of Psychiatrists

Non-adherence to antipsychotic medication regimens: associations with resource use and costs

Martin Knapp, PhD

LSE Health and Social Care, London School of Economics and Political Science, and Centre for the Economics of Mental Health, Institute of Psychiatry, London, UK

Derek King, MSc

LSE Health and Social Care, London School of Economics and Political Science, London, UK

Klaus Pugner, PhD

Global Epidemiology and Outcomes Research, Bristol-Myers Squibb, Waterloo, Belgium, and LSE Health and Social Care, London School of Economics and Political Science, London, UK

Pablo Lapuerta, MD

Global Epidemiology and Outcomes Research, Bristol-Myers Squibb, Waterloo, Belgium

Correspondence: Professor Martin Knapp, Centre for the Economics of Mental Health, PO Box 24, David Goldberg Centre, Institute of Psychiatry, Denmark Hill, London SE5 8AF, UK. E-mail: M.Knapp{at}lse.ac.uk

Declaration of interest K.P. and P.L. are employees of Bristol-Myers Squibb, which also provided funding for M.K. and D.K.; D.K. is also funded by the Department of Health.

Background Several factors are thought to influence resource use and costs in treating schizophrenia.

Aims To assess the relative impact of non-adherence and other factors associated with resource use and costs incurred by people with schizophrenia.

Method Secondary analyses were made of data from a 1994 national survey of psychiatric morbidity among adults living in institutions in the UK. Factors potentially relating to resource use and costs were examined using two-part models.

Results Patients who failed to adhere to their medication regimen were over one-and-a-half times as likely as patients who did adhere to it to report use of in-patient services. Non-adherence is one of the most significant factors in increasing external service costs, by a factor of almost 3. Non-adherence predicted an excess annual cost per patient of approximately £2500 for in-patient services and over £5000 for total service use.

Conclusions Resource use and costs are influenced by various factors. Medication non-adherence consistently exhibits an association with higher costs. Further important factors are patient needs and the ability of the system to address them.


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