The cost of relapse, the predictors of relapse, and the role of prior relapse in the treatment of schizophrenia

Background: To assess the direct cost of relapse, the predictors of relapse, and the role of prior relapse in the treatment of schizophrenia in the United States. Methods: Data were drawn from a prospective, observational, noninterventional study of schizophrenia in the United States (7/1997-9/2003). 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 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. Patients with prior relapse were about 3 times more costly than patients without prior relapse. Their higher acute care costs were accompanied by higher costs for outpatient services and medication. They were younger, with earlier age at illness onset, poorer medication adherence, more severe symptoms, higher rate of substance use disorder, and worse functional status. Compared to patients without prior relapse who relapsed in the followup year, patients with prior relapse who relapsed again in the follow-up year had a 5-fold annual hospitalization cost. Baseline predictors of relapse included prior relapse, health insurance coverage, medication nonadherence, younger age at illness onset, and poorer functioning level. Conclusions: Prior relapse is an important predictor of subsequent relapse, associated with higher mental health costs that extend beyond the cost of hospitalization into various outpatient costs. Findings highlight the economic impact of relapse and its relevance to clinicians and health care decision makers.