The cost of relapse and the predictors of relapse in the treatment of schizophrenia.
BACKGROUND
To assess the direct cost of relapse and the predictors of relapse during the treatment of patients with schizophrenia in the United States.


METHODS
Data 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.


RESULTS
Of 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.


CONCLUSIONS
Despite the historical decline in utilization of psychiatric inpatient services, relapse remains an important predictor of subsequent relapse and treatment costs for persons with schizophrenia.
Ascher-Svanum
Haya
H
US Outcomes Research, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA. haya@lilly.com
Zhu
Baojin
B
Faries
Douglas E
DE
Salkever
David
D
Slade
Eric P
EP
Peng
Xiaomei
X
Conley
Robert R
RR
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000553:Ambulatory Care / Q000191:economics; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D016527:Drug Costs; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D055118:Medication Adherence; D011336:Probability; D057216:Propensity Score; D011446:Prospective Studies; D012008:Recurrence; D012559:Schizophrenia / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D012565:Schizophrenic Psychology; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology
D014150:Antipsychotic Agents