The Economic Impact of Cognitive Impairment and Negative Symptoms in Schizophrenia: A Targeted Literature Review With a Focus on Outcomes Relevant to Health Care Decision-Makers in the United States.

Abstract.

Objective: To conduct a targeted literature review to examine the impact of cognitive impairment and negative symptoms among patients with schizophrenia treated in the United States across a range of outcomes pertinent to the US health care system decision-makers, such as payers and policy-makers.

Data Sources: The authors searched EMBASE and PubMed from January 2012 to January 2024. Search terms included schizophrenia, cognitive impairment and negative symptoms, and direct medical and nonmedical, indirect, and societal outcomes.

Study Selection: Considered for inclusion were US-based studies reporting on the relationship between cognitive impairment or negative symptoms and direct medical and nonmedical, indirect, and societal outcomes in patients with schizophrenia. A total of 4,212 articles were initially identified for screening.

Data Extraction: One reviewer extracted data and another reviewer ensured studies met Population, Intervention, Comparison, Outcomes, Study Design-Time Period (PICOS-T) criteria for inclusion and exclusion.

Results: Eight studies (n = 262,683) were included that reported specifically on associations between cognitive impairment or negative symptoms and targeted outcomes. Patients with schizophrenia and moderate/severe cognitive impairment had a 100% increase in relapse-related hospitalizations (0.6 vs 0.3, adjusted incidence rate ratio = 1.85, P < .05) and ER visits (0.4 vs 0.2, adjusted odds ratio = 1.77, P < .05) vs patients with no/mild cognitive impairment. Additionally, there was an almost 50% increase in outpatient visits (8.4 vs 5.5, P < .001) and inpatient admissions (6.8 vs 4.5, P < .001) over the study period (2014 Q1-2017 Q4) for patients with negative symptoms vs without negative symptoms. Direct nonmedical, indirect, and societal outcomes are described.

Conclusions: This review highlights the economic burden of cognitive impairment and negative symptoms by focusing on outcomes relevant to health care decision-makers in the United States.