Schizophrenia Patients With Cognitive Deficits: Factors Associated With Costs

Cognitive deficits in people with schizophrenia are associ-ated with poor functioning and lower quality of life. Be-cause 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 cogni-tion and costs among people with schizophrenia. Baseline data collected between 1999 and 2002 from a randomized controlled trial of cognitive remediation therapy were an-alyzed. 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 dif-ficulties, and at least 1 year since first contact with psy-chiatric services. Cognition levels, social functioning, symptoms, sociodemographic characteristics, and retro-spective use of health/social care and other resources were measured. Average public sector costs were estimated to be £15 078 ($23 824) 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 fit-ted well and showed a significant relationship. In people with schizophrenia and severe cognitive impairment, improvements in either overall cognition or specific cogni-tive 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. Key words: service utilization/structural equation models/remediatio