title: Schizophrenia patients with cognitive deficits: factors associated with costs.
abstract: Cognitive deficits in people with schizophrenia are associated with poor functioning and lower quality of life. Because few studies have examined their relationship with service use or costs, it is unclear whether effective cognitive remediation interventions have potential for economic impacts. This study examined associations between cognition and costs among people with schizophrenia. Baseline data collected between 1999 and 2002 from a randomized controlled trial of cognitive remediation therapy were analyzed. A total of 85 participants were recruited from a London mental health trust if they had a diagnosis of schizophrenia, evidence of cognitive/social functioning difficulties, and at least 1 year since first contact with psychiatric services. Cognition levels, social functioning, symptoms, sociodemographic characteristics, and retrospective use of health/social care and other resources were measured. Average public sector costs were estimated to be 15 078 pounds(23 824 dollars) for a 6-month period. Associations between health/social care costs and type and severity of cognition were examined using structural equation models. No significant relationships were found between cognition and costs in a model based on 3 independent constituent components of cognition (cognitive shifting, verbal working memory, and response inhibition), although a model with covarying cognition components fitted the observed data well. A model with cognition as a single construct both fitted well and showed a significant relationship. In people with schizophrenia and severe cognitive impairment, improvements in either overall cognition or specific cognitive components may impact on costs. Further investigation in larger samples is needed to confirm this finding and to explore its generalizability to those with less severe deficits.
authors.affiliation: Centre for the Economics of Mental Health, Institute of Psychiatry, King's College London, De Crespigny Park, London, UK. a.patel@iop.kcl.ac.uk
authors.forename: Anita
authors.initials: A
authors.lastname: Patel
authors.forename: Brian
authors.initials: B
authors.lastname: Everitt
authors.forename: Martin
authors.initials: M
authors.lastname: Knapp
authors.forename: Clare
authors.initials: C
authors.lastname: Reeder
authors.forename: Deidre
authors.initials: D
authors.lastname: Grant
authors.forename: Christine
authors.initials: C
authors.lastname: Ecker
authors.forename: Til
authors.initials: T
authors.lastname: Wykes
mesh_terms: D000328:Adult; D003072:Cognition Disorders / Q000191:economics* / Q000534:rehabilitation; D015928:Cognitive Behavioral Therapy / Q000191:economics*; D004739:England; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000191:economics* / Q000706:statistics & numerical data; D018803:Models, Economic; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000191:economics / Q000706:statistics & numerical data; D011594:Psychometrics; D012559:Schizophrenia / Q000191:economics* / Q000534:rehabilitation; D012565:Schizophrenic Psychology; D012917:Social Adjustment; D016896:Treatment Outcome; D014600:Utilization Review / Q000706:statistics & numerical data