Investigating Functional Status and Healthcare Resource Utilization of Patients With Cognitive Impairment Associated With Schizophrenia: Findings From a Real-World Noninterventional Study
Author(s)
Ashley Wu, MHS1, Benjamin Fell, PhD2, Monika Frysz, PhD3, Dalila Monica Moisescu, MPhil2, Georgina Ireland, PhD2, Rashmi Patel, MD, PhD4, Suzanne St Rose, PhD1, Ceyda Uysal, MSc2, Theresa Cassidy, MPH5.
1Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany, 2Akrivia Health, Department of Research, Oxford, United Kingdom, 3Boehringer Ingelheim, Ltd., Real World Evidence CoE, Bracknell, United Kingdom, 4Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom, 5Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT, USA.
1Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany, 2Akrivia Health, Department of Research, Oxford, United Kingdom, 3Boehringer Ingelheim, Ltd., Real World Evidence CoE, Bracknell, United Kingdom, 4Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom, 5Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT, USA.
OBJECTIVES: Cognitive impairment (CI) in patients with schizophrenia is associated with greater disease severity, functional impairment and healthcare resource utilization (HCRU) relative to patients without cognitive impairment associated with schizophrenia (CIAS). This study used natural language processing (NLP) to identify patients with CIAS, and investigated the functional status and HCRU of schizophrenia patients with and without CIAS.
METHODS: Patients ≥18 years with first schizophrenia diagnosis and mention of CI (1-Jan-2005 to 31-Dec-2023) were identified from the Akrivia Health secondary mental healthcare dataset (England and Wales). Patients with dementia, mild CI, intellectual disability, or first CI mention >3 months post-diagnosis were excluded. CIAS status and NLP-CI scores (0 [non-CIAS]; 1-5 [CIAS]) were determined from unstructured electronic healthcare records using NLP. Functional status and HCRU were characterised by presence/absence of CIAS (binary analysis) and NLP-CI score (ordinal comparison) using Health of Nations Outcome Scales (HoNOS)-item 12 (occupation/daytime activities), HoNOS-social subscale (item 9 [relationships], item 10 [daily living activities], item 11 [living conditions/domestic routine], item-12 [occupation/daytime activities]; higher HoNOS score correlates to worse functioning), number of referrals to psychiatric services, and number of inpatient admissions. Associations between CI and patient characteristics were analysed using univariate and multivariable logistic regression analyses.
RESULTS: Patients (N=35,710) were stratified as having CIAS (n=21,410) or as non-CIAS (n=14,300). For HoNOS-item 12 and HoNOS-social subscale, CIAS patients demonstrated worse functioning versus non-CIAS patients (p<0.001). Mean HoNOS scores increased at higher NLP-CI scores for HoNOS-items 9, 10, 11 and 12. The proportion of patients with ≥2 referrals was higher for CIAS (NLP-CI=5) patients (71.8%) versus non-CIAS (NLP-CI=0) patients (22.3%). The proportion of patients with ≥1 inpatient admission was higher for CIAS (NLP-CI=5) patients (60.2%) versus non-CIAS (NLP-CI=0) patients (8.4%).
CONCLUSIONS: CIAS patients had worse HoNOS-social subscale scores, increased referrals, and inpatient admissions post-schizophrenia diagnosis, reinforcing the functional impact and economic burden of CIAS.
METHODS: Patients ≥18 years with first schizophrenia diagnosis and mention of CI (1-Jan-2005 to 31-Dec-2023) were identified from the Akrivia Health secondary mental healthcare dataset (England and Wales). Patients with dementia, mild CI, intellectual disability, or first CI mention >3 months post-diagnosis were excluded. CIAS status and NLP-CI scores (0 [non-CIAS]; 1-5 [CIAS]) were determined from unstructured electronic healthcare records using NLP. Functional status and HCRU were characterised by presence/absence of CIAS (binary analysis) and NLP-CI score (ordinal comparison) using Health of Nations Outcome Scales (HoNOS)-item 12 (occupation/daytime activities), HoNOS-social subscale (item 9 [relationships], item 10 [daily living activities], item 11 [living conditions/domestic routine], item-12 [occupation/daytime activities]; higher HoNOS score correlates to worse functioning), number of referrals to psychiatric services, and number of inpatient admissions. Associations between CI and patient characteristics were analysed using univariate and multivariable logistic regression analyses.
RESULTS: Patients (N=35,710) were stratified as having CIAS (n=21,410) or as non-CIAS (n=14,300). For HoNOS-item 12 and HoNOS-social subscale, CIAS patients demonstrated worse functioning versus non-CIAS patients (p<0.001). Mean HoNOS scores increased at higher NLP-CI scores for HoNOS-items 9, 10, 11 and 12. The proportion of patients with ≥2 referrals was higher for CIAS (NLP-CI=5) patients (71.8%) versus non-CIAS (NLP-CI=0) patients (22.3%). The proportion of patients with ≥1 inpatient admission was higher for CIAS (NLP-CI=5) patients (60.2%) versus non-CIAS (NLP-CI=0) patients (8.4%).
CONCLUSIONS: CIAS patients had worse HoNOS-social subscale scores, increased referrals, and inpatient admissions post-schizophrenia diagnosis, reinforcing the functional impact and economic burden of CIAS.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
SA58
Topic
Study Approaches
Disease
Mental Health (including addition)