Does change in cognitive function predict change in costs of care for people with a schizophrenia diagnosis following cognitive remediation therapy?

Abstract

Background and aims: 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).

Conclusion: 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.

Keywords: cognition; cognitive predictors; executive function; functioning; working memory.

Fig. 1.

Model with 3 cognitive variables with standardized parameter estimates. All pathways were estimated but small parameter estimates are not shown. **P < .05.

Fig. 2.

Single latent cognition factor model with standardized parameter estimates. Although all pathways were estimated in the model, some small parameter estimates are not shown. *P < .1; **P < .05, ***P < .01.

Fig. 3.

Model with 3 cognitive variables and 2 cost variables, with standardized parameter estimates. Although all pathways were estimated, small parameter estimates <0.1 are not shown. *P < .1; **P < .05, ***P < .01.

Fig. 4.

Single latent cognition factor model with standardized parameter estimates. Although all pathways were estimated in the model, some small parameter estimates are not shown. *P < .1; **P < .05, ***P < .01.