The Societal Cost of Schizophrenia: A Systematic Review
Cost-of-illness (COI) studies provide useful information on the economic burden that schizophrenia imposes on a society.
This study aims to give a general overview of COI studies for schizophrenia and to compare the societal cost of schizophrenia across countries. It also aims to identify the main cost components of schizophrenia and factors associated with higher societal cost to improve the quality and reporting of COI studies for schizophrenia.
We performed an electronic search on multiple databases (MEDLINE, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Health Management Information Consortium [HMIC] and the System for Information on Grey Literature [openSIGLE]) to identify COI studies of schizophrenia published between 1996 and 2016. The primary outcome of this review was societal cost per schizophrenia patient, by cost component. All costs were converted to $US, year 2015 values.
We included 19 studies in this review. The annual societal cost per patient varied from $US5818 in Thailand to $US94,587 in Norway; whereas the lifetime societal cost per patient was estimated to be $US988,264 in Australia (all year 2015 values). The main cost drivers were direct healthcare costs and productivity losses. Factors associated with higher individual costs included patient demographics, severity of disease and methods used to calculate the costs of productivity losses and comorbidities.
This review highlights the large economic burden of schizophrenia. The magnitude of the cost estimates differs considerably across countries, which might be caused by different economic conditions and healthcare systems and widespread methodological heterogeneity among COI studies. Proposed recommendations based on this review can be used to improve the consistency and comparability of COI studies for schizophrenia.
KeywordsSchizophrenia Gross Domestic Product Productivity Loss Schizophrenia Patient Societal Cost
The authors thank Dr. James Shearer for proof reading this manuscript.
Huajie Jin conducted the systematic review and led the writing of the paper. Iris Mosweu performed the first round (title and abstract) screening and the second round (full-text) sifting as the second reviewer, and contributed to the writing of the paper. Huajie Jin will serve as a guarantor for the overall content of the manuscript.
Compliance with Ethical Standards
No funding was received for this review.
Conflict of interest
HJ receives salary support from the National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London. IM receives salary support from King’s College London. The views expressed are those of the authors and not necessarily those of the NIHR. HJ and IM have no conflicts of interest to declare.
- 2.The Schizophrenia Commission. The abandoned illness: a report by the Schizophrenia Commission. London: Rethink Mental Illness; 2012.Google Scholar
- 7.Segel JE. Cost-of-illness studies: a primer. RTI-UNC Center of Excellence in Health Promotion Economics RTI International. 2006. p. 1–39.Google Scholar
- 9.Drummond M, O’Brien B, Stoddart GL, et al. Methods for the economic evaluation of health care programmes, 2nd ed. Oxford: Oxford University Press; 1997Google Scholar
- 10.Gold M. Panel on cost-effectiveness in health and medicine. Med Care. 1996;34(12 Suppl):DS197–199.Google Scholar
- 13.Access Economics. Bipolar disorder: costs. An analysis of the burden of bipolar disorder and related suicide in Australia. Canberra: Report for SANE Australia; 2002.Google Scholar
- 15.Gold MR. Cost-effectiveness in health and medicine. Oxford: Oxford University Press; 1996.Google Scholar
- 19.Genduso LA, Haley JC. Cost of illness studies for schizophrenia: components, benefits, results, and implications. Am J Managed Care. 1997;3(6):873–7.Google Scholar
- 22.Tajima-Pozo K, de Castro Oller MJ, Lewczuk A, Montanes-Rada F. Understanding the direct and indirect costs of patients with schizophrenia. Version 2. F1000Res. 2015;4:182. doi: 10.12688/f1000research.6699.2.
- 23.McEvoy JP. The costs of schizophrenia. J Clin Psychiatry. 2007;14:4–7.Google Scholar
- 27.Rice DP, Miller LS. The economic burden of schizophrenia: Conceptual and methodological issues, and cost estimates. In: Moscarelli M, Rupp A, Sartorius N, editors. Handbook of mental health economics and health policy. Volume 1: schizophrenia. Oxford: Wiley; 1996. p. 321–334.Google Scholar
- 30.Rice DP, Miller LS. Health economics and cost implications of anxiety and other mental disorders in the United States. Br J Psychiatry Suppl. 1998;34:4–9.Google Scholar
- 37.Langley-Hawthorne C. Modeling the lifetime costs of treating schizophrenia in Australia. Clin Ther. 1997;19(6):1470–95.Google Scholar
- 42.Sung MC, Cho SJ, Hong JJ, Hahm BJ, Hyo JL, Park JI, et al. Economic burden of schizophrenia in South Korea. J Korean Med Sci. 2008;2:167–75.Google Scholar
- 43.World Federation for Mental Health. Keeping care complete fact sheet: international findings. 2013. Available from: http://www.supportingfamilies.org.nz/Libraries/Documents/Keeping_Care_Complete_Survey.sflb.ashx. Accessed Aug 2016.