The Economic Impact of Cumulative Metabolic Comorbidity Burden in Schizophrenia: A Claims-Based Analysis of Medical Costs in the United States

Metabolic comorbidities, including central adiposity, dyslipidemia, insulin resistance, and hypertension, are common in individuals with schizophrenia and contribute to an increased risk of cardiovascular disease and related mortality. There is limited evidence quantifying the economic burden of metabolic comorbidities in schizophrenia. This study aimed to assess the impact of cumulative metabolic comorbidity burden on medical costs in individuals with schizophrenia using claims data. A retrospective cohort study was conducted using the STATinMED Real World Data Insights database covering the period 2018–2024 in the United States (US). Adults with schizophrenia were grouped by number of metabolic comorbidities (obesity, hyperlipidemia, hypercholesterolemia, diabetes, and/or hypertension). Propensity score matching was applied to balance selected baseline characteristics in individuals with and without metabolic comorbidities. The primary outcome was all-cause medical costs, during a 12-month follow-up, adjusted for insurance status and inflation. Overall, 122,248 individuals were eligible. After matching, the numbers for metabolic comorbidities and individuals in each group were: 0, n = 40,552; 1, n = 15,840; 2, n = 11,833; 3, n = 8119; 4, n = 4074; and 5, n = 686. Estimated total medical costs increased with the number of metabolic comorbidities; individuals with five metabolic comorbidities incurred mean costs of US$34,441 per person per year, over 4 times higher than the $8396 cost for individuals with none. A similar pattern was observed for estimated outpatient, inpatient, and stay-related costs, with 3.5-, 2.3- and 1.7-fold increases, respectively. There is a substantial economic burden associated with cumulative metabolic comorbidities in individuals with schizophrenia. Prevention and management of metabolic comorbidities in this population includes early risk assessments, lifestyle modification, and the selection of antipsychotic medications with few metabolic adverse effects. Addressing metabolic comorbidities should be a key component of multidisciplinary care to reduce health-related and economic impacts in schizophrenia. Metabolic disorders include obesity, high fat levels in blood, high blood cholesterol, diabetes, and high blood pressure. When several occur together, this is known as metabolic syndrome. People with metabolic syndrome are at increased risk of heart disease and stroke. In the United States, about a third of people with schizophrenia (which is a serious mental health condition) have three or more metabolic disorders. Many available treatments for schizophrenia can increase the risk of developing metabolic disorders. This study compared medical costs in adults with schizophrenia who had at least one metabolic disorder with those who did not. The study used a large set of healthcare claims data from the United States, covering the years from 2018 to 2024. The results showed that the more metabolic disorders a person had, the more costly their healthcare. People with five metabolic disorders had medical costs that were about $34,000 a year in total, which is over four times more than people with schizophrenia without metabolic disorders. The costs for clinic visits and hospital stays increased as the number of metabolic disorders increased. Treating metabolic disorders and using medications for schizophrenia with fewer metabolic side effects, like weight gain, could help people with schizophrenia stay healthier and reduce the overall costs of medical care.