Patient Characteristics and Health Care Resource Utilization of Cognitive Impairment Among Patients with Schizophrenia in the Veterans Affairs Administration System

OBJECTIVES: The objective of this study was to describe the clinical and demographic characteristics, treatment pattern, and healthcare resource utilization (HCRU) related to cognitive impairment (CI) among Veteran Affair (VA) patients with schizophrenia.

METHODS: This retrospective cohort study used the VA Informatics and Computing Infrastructure database from January 2000 to September 2022. This study included adults with at least two schizophrenia diagnoses, and a minimum of 12 months of enrollment prior to the index date. CI was identified based on health factors data, diagnosis/procedural codes, and medication use. The study population was followed for at least 12 months after index date.

RESULTS: This study included 58,776 individuals diagnosed with schizophrenia. The average age was 52.5 years, with 92.4% being male. CI was identified in 21.5% of the study population. Compared to those without CI, individuals with CI were older on average (55.1 vs. 51.8 years, p<0.01), had a higher percentage of females (8.8% vs. 7.3%, p<0.01), a higher percentage of Black individuals (36.2% vs. 33.5%, p<0.01), a higher prevalence of obesity (39.1% vs. 33.9%, p<0.01), and a higher Charlson Comorbidity Index score (1.49 vs. 1.06, p<0.01). During the follow-up period, those with CI had significantly higher utilization of antidepressants (47.2% vs. 39.4%, p<.01) and psychotherapy services (55.7% vs. 39.7%, p<.01). Additionally, the average per patient per year (PPPY) number of hospitalization visits for those with CI was almost 40% higher (1.0 vs. 0.7, p<.01), and they experienced nearly double the average PPPY number of emergency department visits (0.6 vs. 0.3, p<.01).

CONCLUSIONS: The study's findings reveal a significant association between CI and increased HCRU in VA patients with schizophrenia. These results reinforce the importance of incorporating CI management into the overall treatment plans for individuals living with schizophrenia.