Abstract
BackgroundTo assess the direct cost of relapse and the predictors of relapse during the treatment of patients with schizophrenia in the United States.MethodsData were drawn from a prospective, observational, noninterventional study of schizophrenia in the United States (US-SCAP) conducted between 7/1997 and 9/2003. Patients with and without relapse in the prior 6 months were compared on total direct mental health costs and cost components in the following year using propensity score matching method. Baseline predictors of subsequent relapse were also assessed.ResultsOf 1,557 participants with eligible data, 310 (20%) relapsed during the 6 months prior to the 1-year study period. Costs for patients with prior relapse were about 3 times the costs for patients without prior relapse. Relapse was associated with higher costs for inpatient services as well as for outpatient services and medication. Patients with prior relapse were younger and had onset of illness at earlier ages, poorer medication adherence, more severe symptoms, a higher prevalence of substance use disorder, and worse functional status. Inpatient costs for patients with a relapse during both the prior 6 months and the follow-up year were 5 times the costs for patients with relapse during the follow-up year only. Prior relapse was a robust predictor of subsequent relapse, above and beyond information about patients' functioning and symptom levels.ConclusionsDespite the historical decline in utilization of psychiatric inpatient services, relapse remains an important predictor of subsequent relapse and treatment costs for persons with schizophrenia.
Highlights
To assess the direct cost of relapse and the predictors of relapse during the treatment of patients with schizophrenia in the United States
Data source Data were used from the US Schizophrenia Care and Assessment Program (US-SCAP), a large (N = 2,327) 3year prospective, observational, noninterventional study of schizophrenia treatment in usual-care settings in the United States conducted between July 1997 and September 2003
Current findings demonstrate that the annual mental health cost of relapsed patients is about 2 to 5 times higher than for non-relapsed patients, depending on whether the patients had relapsed in the 6 months prior to the 1year study period
Summary
To assess the direct cost of relapse and the predictors of relapse during the treatment of patients with schizophrenia in the United States. Except for results from 1 published study [1], information about potential predictors of relapse and its associated treatment costs in the United Stated are scarce. Information about the cost of relapse in schizophrenia and the predictors of relapse is of interest to clinicians, payers, and other health care decision makers. Intensive outpatient service interventions, such as assertive community treatment, partial hospitalization programs, and programs for persons with co-occurring addictive disorders, which are designed for persons at risk of acute relapse, could help prevent or minimize relapses and attendant health care costs. Intensive outpatient interventions cost too much to be offered to all patients with schizophrenia who might benefit from them. Accurate prediction of risk of relapse is critical to identifying persons who may need these intensive outpatient interventions
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