Cognitive dysfunction reflected in schizophrenia healthcare costs

By Eleanor McDermid, Senior medwireNews Reporter

Cognitive dysfunction has direct and indirect effects on healthcare costs in patients with schizophrenia, research suggests.

The findings indicate that “executive change may be important if we are to reduce disability and resultant costs to society and healthcare systems,” say study author Clare Reeder (Institute of Psychiatry, King’s College London, UK) and team.

The data come from a previously published randomised controlled trial comparing 40 sessions of cognitive remediation therapy with treatment as usual in 85 schizophrenia patients.

The researchers initially looked at the change in three cognition variables – the Digit Span test (verbal working memory), Trail-Making test (cognitive shifting) and Hayling Task (response inhibition). Receiving cognitive remediation therapy rather than usual treatment predicted change in verbal working memory, but none of the cognitive variables were significantly associated with change in healthcare costs.

They then looked at a single latent cognition factor representing change in all the cognitive tests administered. Although not directly associated with costs, this factor was significantly associated with change in depression, which in turn was significantly associated with change in costs between baseline and 6 months after therapy.

This suggests “that depression may play an important and frequently overlooked role in accounting for links between cognitive and functional changes”, writes the team in Schizophrenia Bulletin.

The models included total healthcare costs, but to avoid an unbalancing effect of hospital admissions costs, the researchers reassessed the models including only special accommodation and day-care costs.

Again, the three individual cognition variables were not associated with costs, but the single latent factor was, this time showing a significant direct association.

“The residential care finding was consistent with our hypothesis that improved cognition would lead to a reduction in disability and a consequential reduced requirement for specialized accommodation”, say Reeder et al.

They add that the association of the latent factor, but not the three individual variables with costs, “may suggest that the quantity rather than type of cognitive improvement is important in promoting cost change.”

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