title: Does change in cognitive function predict change in costs of care for people with a schizophrenia diagnosis following cognitive remediation therapy?
abstract: OBJECTIVE
  Schizophrenia leads to significant personal costs matched by high economic costs. Cognitive function is a strong predictor of disabilities in schizophrenia, which underpin these costs. This study of cognitive remediation therapy (CRT), which has been shown to improve cognition and reduce disability in schizophrenia, aims to investigate associations between improvements in cognition and cost changes.
  
  
  METHODS
  Eighty-five participants with schizophrenia were randomized to receive CRT or treatment as usual and were assessed at baseline, posttherapy, and 6 month follow-up. Four structural equation models investigated associations between changes in cognitive function and costs of care.
  
  
  RESULTS
  All 4 models provided a good fit. Improvement in 3 individual cognitive variables did not predict total cost changes (model 1). But improvement in a single latent cognition factor was associated with a reduction in depression, which in turn was associated with reduced subsequent total costs (model 2). No significant associations with constituent daycare and special accommodation cost changes were apparent with 3 individual cognitive change variables (model 3). But improvement in a single latent cognitive change variable was associated with subsequent reductions in both daycare and special accommodation costs (model 4).
  
  
  CONCLUSIONS
  This study exemplifies a method of using cost changes to investigate the effects and mechanisms of CRT and suggests that executive function change may be an important target if we are to reduce disability and resultant health and social care costs.
authors.affiliation: Department of Psychology, Institute of Psychiatry, King's College London, London, UK; clare.reeder@kcl.ac.uk.
authors.forename: Clare
authors.initials: C
authors.lastname: Reeder
authors.affiliation: Department of Biostatistics, Institute of Psychiatry, King's College London, London, UK;
authors.forename: Victoria
authors.initials: V
authors.lastname: Harris
authors.affiliation: Department of Biostatistics, Institute of Psychiatry, King's College London, London, UK;
authors.forename: Andrew
authors.initials: A
authors.lastname: Pickles
authors.affiliation: Department of Health Service and Population Research, Institute of Psychiatry, King's College London, London, UK.
authors.forename: Anita
authors.initials: A
authors.lastname: Patel
authors.affiliation: Department of Psychology, Institute of Psychiatry, King's College London, London, UK;
authors.forename: Matteo
authors.initials: M
authors.lastname: Cella
authors.affiliation: Department of Psychology, Institute of Psychiatry, King's College London, London, UK;
authors.forename: Til
authors.initials: T
authors.lastname: Wykes
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D017281:Cost of Illness; D056344:Executive Function / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012559:Schizophrenia / Q000191:economics / Q000451:nursing / Q000534:rehabilitation
keywords: cognition; cognitive predictors; executive function; functioning; working memory