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Article Index
Cost of Relapse in Schizophrenia
Method
Results
Discussion
Conclusion
All Pages

Schizophrenia Bulletin, Vol. 21, No. 3, 1995
National Institute of Mental Health

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Abstract

To estimate the national annual cost of rehospitalization for multiple-episode schizophrenia outpatients, and to determine the relative cost burden from loss of medication efficacy and from medication noncompliance, the yearly number of neuroleptic-responsive multiple-episode schizophrenia inpatients in the United States who are discharged back to outpatient treatment was estimated. The cohort at risk for future relapse and rehospitalization was determined. The research literature on the expected rates of relapse for schizophrenia patients on maintenance antipsychotic medication was reviewed; in particular, monthly relapse rates under the optimal medication conditions of compliant patients taking optimal doses of a depot neuroleptic (optimal neuroleptic dose) and under the less optimal conditions of patients stopping medication (medication noncompliant) was estimated. Using established noncompliance rates from the literature, it became possible to estimate a "real world" rehospitalization rate for this cohort, as well as the relative burden accruing from loss of medication efficacy and from medication non-compliance. Finally, cost estimates for index hospitalizations and rehospitalizations were derived from data on national expenditures for inpatient mental health care. The monthly relapse rates are estimated to be 3.5 percent per month for patients on maintenance neuroleptics and 11.0 percent per month for patients who have discontinued their medication. Postdischarge noncompliance rates in community settings are estimated to be 7.6 percent per month. These estimates were entered into a survival analysis model to determine the real world relapse rate of this cohort. An estimated 257,446 multiple-episode (>= two hospitalizations) schizophrenia patients were discharged from short-stay (=< 90 Schizophrenia Bulletin, 21(3): 419-429, 1995.

Schizophrenia inflicts incalculable suffering on patients and their families, and imposes a substantial economic burden on society (Wyatt and Clark 1987; McGuire 1991). Although cost estimates fail to capture the devastating human dimensions of the illness, they can help guide the allocation of treatment resources. Economists traditionally distinguish between direct and indirect costs. Direct costs are the actual dollar expenditures related to the treatment of an illness and typically include institutional care, professional services, and medications. Indirect costs include lost productivity and losses due to premature death. This article focuses on direct costs. Not surprisingly, the direct cost of schizophrenia is very large (Gunderson and Mosher 1975; Rice et al. 1990); a recent estimate of the total annual direct cost of schizophrenia is $19 billion (Wyatt et al., in press).

Many cost studies divide direct costs into component costs (e.g., inpatient treatment, outpatient treatment, jail, medication, etc.). A limitation of this approach, however, is that it is static and provides little information about specific costs that come from particular aspects of the disease, patient behavior, or treatment. For example, an obvious issue in the maintenance (outpatient) treatment of schizophrenia is the risk of relapse and its associated costs. Two major contributors to relapse during maintenance treatment are loss of medication efficacy and medication noncompliance. Clearly, it would be very useful to better understand the relationship between specific problems such as these and the ultimate cost of schizophrenia.

Disorders - Schizophrenia