Original articles

Issue 4 - December 2025

Cognition and direct costs in schizophrenia spectrum disorders. Preliminary results from a retrospective longitudinal study

Authors

Irene Calzavara Pinton , Gabriele Nibbio , Lorenzo Bertoni , Nicola Necchini , Daniela Zardini , Antonio Baglioni , Stefano Paolini , Laura Poddighe , Jacopo Lisoni , Giacomo Deste , Stefano Barlati , Antonio Vita

Key words: autism spectrum disorder,, direct costs, cognition, psychosocial functioning, clinical severity
DOI: 10.36180/2421-4469-2025-1489
Publication Date: 2026-03-06

Abstract

Objectives. Schizophrenia spectrum disorders (SSD) accounts for a substantial economic burden on healthcare, with roughly half being direct costs. Hospitalization and use of services in general account for the majority (81%) of direct costs. Given the impact of cognitive impairment in SSD, a clearer understanding of cognition's impact on healthcare expenses for SSD is of clinical and scientific relevance.

Methods. A total of 70 subjects living with SSD were included in this preliminary ad-interim analysis: for each participant, cognitive, clinical, sociodemographic data, as well as information regarding the use of mental health services during the year 2023 was collected and analyzed. Predictors of total direct costs were assessed using multiple linear regression models.

Results. The average direct yearly healthcare expenditure per patient with SSD related to service utilization amounted to €58,932.44. Several variables were associated with increased costs (all p<0.05): poorer Brief Assessment of Cognition in Schizophrenia (BACS) verbal fluency performance, alcohol or substance abuse, higher Clinical Global Impression-Severity (CGI-S) scores, higher total and subscale scores on the Positive and Negative Syndrome Scale, higher Health of the Nation Outcome Scales (HoNOS) score, and lower Global Assessment of Functioning (GAF) scores. Higher CGI-S score (p<0.001, β=-0.581), lower BACS verbal fluency performance (p=0.003 β=−0.349), and the presence of substance use (p=0.014, β=0.293) emerged as individual predictors of increased costs.

Conclusion. The findings of this study highlight the importance of implementing tailored psychosocial interventions in individuals with SSD, with the additional goal of a reduction in overall healthcare expenses.

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Authors

Irene Calzavara Pinton - Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy

Gabriele Nibbio - Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy

Lorenzo Bertoni - Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy

Nicola Necchini - Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy

Daniela Zardini - Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy

Antonio Baglioni - Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy

Stefano Paolini - Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy

Laura Poddighe - Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy

Jacopo Lisoni - 2 Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy

Giacomo Deste - Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy

Stefano Barlati - Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy

Antonio Vita - Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Copyright

Copyright (c) 2026 Italian Journal of Psychiatry

How to Cite
Calzavara Pinton, I., Nibbio, G., Bertoni, L., Necchini, N., Zardini, D., Baglioni, A., Paolini, S., Poddighe, L., Lisoni, J., Deste, G., Barlati, S., & Vita, A. (2026). Cognition and direct costs in schizophrenia spectrum disorders. Preliminary results from a retrospective longitudinal study . Italian Journal of Psychiatry, 11(4). https://doi.org/10.36180/2421-4469-2025-1489
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