The cost of relapse and the predictors of relapse in the treatment of schizophrenia

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.

Age at onset and the outcomes of schizophrenia: A systematic review and meta‐analysis

“…The largest portion of the patients was from the European part of the W‐SOHO study, in which there was no relationship between age at onset and relapsing (Haro et al, 2006). Three studies reported a significant relationship between age at onset and relapsing: Ascher‐Svanum et al (2010) found that those with relapse during the 1‐year follow‐up period were over 2 years younger at onset than those not having relapse and (Altamura et al’s (2001) results showed a 2.9‐year difference. Eaton's results in India, however, showed that age at onset above 25 increased the risk of relapsing (Eaton, Thara, Federman, & Tien, 1998).…”

A randomized controlled trial comparing self-referral to inpatient treatment and treatment as usual in patients with severe mental disorders

“…A large proportion of the total health care costs of schizophrenia and BD are due to hospitalizations (7,8). Rehospitalizations are costly and are markers of reduced function and quality of life of patients with psychotic disorders and their families (9)(10)(11). Internationally the concept of recovery has had a growing influence on mental health services (12) emphasizing patients self-direction, empowerment and responsibility (13).…”

Treatment response and tolerability with once-monthly paliperidone palmitate initiated shortly after hospital admission in patients with schizophrenia

“…Both partial adherence and non-adherence to oral antipsychotic medication are challenging aspects of schizophrenia treatment, and are associated with increased risk of relapse, rehospitalisation and suicide (Ascher-Svanum et al 2010;Novick et al 2010;Higashi et al 2013). Non-adherence to oral antipsychotic medication has been shown to result in an almost five-fold increase in the risk of relapse (Robinson et al 1999).…”