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Open Access Research article

The cost of relapse and the predictors of relapse in the treatment of schizophrenia

Haya Ascher-Svanum1*, Baojin Zhu2, Douglas E Faries2, David Salkever3, Eric P Slade45, Xiaomei Peng2 and Robert R Conley6

Author Affiliations

1 US Outcomes Research, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA

2 US Statistics, Lilly USA, LLC, Lilly Corporate Center, Indianapolis, IN 46285, USA

3 Department of Public Policy, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA

4 University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA

5 VA VISN 5 Mental Illness Research, Education, and Clinical Center, US Department of Veterans Affairs, 10 North Greene Street, Baltimore, MD 21201, USA

6 US Medical Division, Lilly USA, LLC, Lilly Corporate Center, Indianapolis, IN 46285, USA

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BMC Psychiatry 2010, 10:2  doi:10.1186/1471-244X-10-2

Published: 7 January 2010



To assess the direct cost of relapse and the predictors of relapse during the treatment of patients with schizophrenia in the United States.


Data were drawn from a prospective, observational, noninterventional study of schizophrenia in the United States (US-SCAP) conducted between 7/1997 and 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 matching method. Baseline predictors of subsequent relapse were also assessed.


Of 1,557 participants with eligible data, 310 (20%) relapsed during the 6 months prior to the 1-year study period. Costs for patients with prior relapse were about 3 times the costs for patients without prior relapse. Relapse was associated with higher costs for inpatient services as well as for outpatient services and medication. Patients with prior relapse were younger and had onset of illness at earlier ages, poorer medication adherence, more severe symptoms, a higher prevalence of substance use disorder, and worse functional status. Inpatient costs for patients with a relapse during both the prior 6 months and the follow-up year were 5 times the costs for patients with relapse during the follow-up year only. Prior relapse was a robust predictor of subsequent relapse, above and beyond information about patients' functioning and symptom levels.


Despite the historical decline in utilization of psychiatric inpatient services, relapse remains an important predictor of subsequent relapse and treatment costs for persons with schizophrenia.