Advertisement

PharmacoEconomics

, Volume 35, Issue 1, pp 25–42 | Cite as

The Societal Cost of Schizophrenia: A Systematic Review

  • Huajie JinEmail author
  • Iris Mosweu
Systematic Review

Abstract

Background

Cost-of-illness (COI) studies provide useful information on the economic burden that schizophrenia imposes on a society.

Objectives

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Schizophrenia Gross Domestic Product Productivity Loss Schizophrenia Patient Societal Cost 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

The authors thank Dr. James Shearer for proof reading this manuscript.

Author contributions

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

Funding

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.

Supplementary material

40273_2016_444_MOESM1_ESM.docx (21 kb)
Supplementary material 1 (DOCX 21 kb)

References

  1. 1.
    Saha S, Chant D, Welham J, McGrath J. A systematic review of the prevalence of schizophrenia. PLoS Med. 2005;2(5):e141.PubMedPubMedCentralCrossRefGoogle Scholar
  2. 2.
    The Schizophrenia Commission. The abandoned illness: a report by the Schizophrenia Commission. London: Rethink Mental Illness; 2012.Google Scholar
  3. 3.
    Wu EQ, Birnbaum HG, Shi L, Ball DE, Kessler RC, Moulis M, et al. The economic burden of schizophrenia in the United States in 2002. J Clin Psychiatry. 2005;66(9):1122–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Goeree R, Farahati F, Burke N, Blackhouse G, O’Reilly D, Pyne J, et al. The economic burden of schizophrenia in Canada in 2004. Curr Med Res Opin. 2005;21(12):2017–28.PubMedCrossRefGoogle Scholar
  5. 5.
    Mangalore R, Knapp M. Cost of schizophrenia in England. J Ment Health Policy Econ. 2007;10(1):23–41.PubMedGoogle Scholar
  6. 6.
    Rice DP. Cost of illness studies: what is good about them? Injury Prev. 2000;6(3):177–9.CrossRefGoogle Scholar
  7. 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
  8. 8.
    Larg A, Moss JR. Cost-of-illness studies: a guide to critical evaluation. Pharmacoeconomics. 2011;29(8):653–71.PubMedCrossRefGoogle Scholar
  9. 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. 10.
    Gold M. Panel on cost-effectiveness in health and medicine. Med Care. 1996;34(12 Suppl):DS197–199.Google Scholar
  11. 11.
    Sindelar J. Social costs of alcohol. J Drug Issues. 1998;28(3):763–80.CrossRefGoogle Scholar
  12. 12.
    Dagenais S, Caro J, Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J. 2008;8(1):8–20.PubMedCrossRefGoogle Scholar
  13. 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
  14. 14.
    Koopmanschap MA, Rutten FF, van Ineveld BM, van Roijen L. The friction cost method for measuring indirect costs of disease. J Health Econ. 1995;14(2):171–89.PubMedCrossRefGoogle Scholar
  15. 15.
    Gold MR. Cost-effectiveness in health and medicine. Oxford: Oxford University Press; 1996.Google Scholar
  16. 16.
    Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535. doi: 10.1136/bmj.b2535.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Ian S, Marcello M, James T. A web-based tool for adjusting costs to a specific target currency and price year. Evid Policy. 2010;6(1):51–9.CrossRefGoogle Scholar
  18. 18.
    Andlin-Sobocki P, Rossler W. Cost of psychotic disorders in Europe. Eur J Neurol. 2005;12(Suppl 1):74–7.PubMedCrossRefGoogle Scholar
  19. 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
  20. 20.
    Knapp M, Mangalore R, Simon J. The global costs of schizophrenia. Schizophr Bull. 2004;30(2):279–93.PubMedCrossRefGoogle Scholar
  21. 21.
    Neil AL, Lewin TJ, Carr VJ. Allocation of resources and psychosis. Aust N Z J Psychiatry. 2003;37(1):15–23.PubMedCrossRefGoogle Scholar
  22. 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. 23.
    McEvoy JP. The costs of schizophrenia. J Clin Psychiatry. 2007;14:4–7.Google Scholar
  24. 24.
    Blomqvist AG, Leger PT, Hoch JS. The cost of schizophrenia: lessons from an international comparison. J Ment Health Policy Econ. 2006;9(4):177–83.PubMedGoogle Scholar
  25. 25.
    Kennedy JL, Altar CA, Taylor DL, Degtiar I, Hornberger JC. The social and economic burden of treatment-resistant schizophrenia: a systematic literature review. Int Clin Psychopharmacol. 2015;29(2):63–76.CrossRefGoogle Scholar
  26. 26.
    Rice DP. The economic impact of schizophrenia. J Clin Psychiatry. 1999;60(suppl. 1):4–6.PubMedGoogle Scholar
  27. 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
  28. 28.
    Phanthunane P, Whiteford H, Vos T, Bertram M. Economic burden of schizophrenia: empirical analyses from a survey in Thailand. J Ment Health Policy Econ. 2012;15(1):25–32.PubMedGoogle Scholar
  29. 29.
    Evensen S, Wisløff T, Lystad J, Bull H, Ueland T, Falkum E. Prevalence, employment rate, and cost of schizophrenia in a high-income welfare society: a population-based study using comprehensive health and welfare registers. Schizophr Bull. 2016;42(2):476–83.PubMedCrossRefGoogle Scholar
  30. 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
  31. 31.
    Desai PR, Lawson KA, Barner JC, Rascati KL. Estimating the direct and indirect costs for community-dwelling patients with schizophrenia. J Pharm Health Serv Res. 2013;4(4):187–94.CrossRefGoogle Scholar
  32. 32.
    Behan C, Kennelly B, O’Callaghan E. The economic cost of schizophrenia in Ireland: a cost of illness study. Irish J Psychol Med. 2008;25(3):80–7.CrossRefGoogle Scholar
  33. 33.
    Ekman M, Granstrom O, Omerov S, Jacob J, Landen M. The societal cost of schizophrenia in Sweden. J Ment Health Policy Econ. 2013;16(1):13–25.PubMedGoogle Scholar
  34. 34.
    Frey S. The economic burden of schizophrenia in Germany: a population-based retrospective cohort study using genetic matching. Eur Psychiatry. 2014;29(8):479–89. doi: 10.1016/j.eurpsy.2014.04.003.PubMedCrossRefGoogle Scholar
  35. 35.
    Goeree R, O’Brien BJ, Goering P, Blackhouse G, Agro K, Rhodes A, et al. The economic burden of schizophrenia in Canada. Can J Psychiatry. 1999;44(5):464–72.PubMedGoogle Scholar
  36. 36.
    Guest JF, Cookson RF. Cost of schizophrenia to UK Society. An incidence-based cost-of-illness model for the first 5 years following diagnosis. Pharmacoeconomics. 1999;15(6):597–10.PubMedCrossRefGoogle Scholar
  37. 37.
    Langley-Hawthorne C. Modeling the lifetime costs of treating schizophrenia in Australia. Clin Ther. 1997;19(6):1470–95.Google Scholar
  38. 38.
    Oliva-Moreno J, Lopez-Bastida J, Osuna-Guerrero R, Montejo-Gonzalez AL, Duque-Gonzalez B. The costs of schizophrenia in Spain. Eur J Health Econ. 2006;7(3):182–8.PubMedCrossRefGoogle Scholar
  39. 39.
    Pletscher M, Mattli R, von Wyl A, Reich O, Wieser S. The societal costs of schizophrenia in Switzerland. J Ment Health Policy Econ. 2015;18(2):93–103.PubMedGoogle Scholar
  40. 40.
    Sado M, Inagaki A, Koreki A, Knapp M, Kissane LA, Mimura M, et al. The cost of schizophrenia in Japan. Neuropsychiatr Dis Treat. 2013;9:787–98.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Sarlon E, Heider D, Millier A, et al. A prospective study of health care resource utilisation and selected costs of schizophrenia in France. BMC Health Serv Res. 2012;12:269–76.PubMedPubMedCentralCrossRefGoogle Scholar
  42. 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. 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.
  44. 44.
    Goeree R, O’Brien BJ, Blackhouse G, Agro K, Goering P. The valuation of productivity costs due to premature mortality: a comparison of the human-capital and friction-cost methods for schizophrenia. Can J Psychiatry. 1999;44(5):455–63.PubMedGoogle Scholar
  45. 45.
    Teplin LA, McClelland GM, Abram KM, Weiner DA. Crime victimization in adults with severe mental illness: comparison with the national crime victimization survey. Arch Gen Psychiatry. 2005;62(8):911–21. doi: 10.1001/archpsyc.62.8.911.PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    Oshima I, Mino Y, Inomata Y. Institutionalisation and schizophrenia in Japan: social environments and negative symptoms. Nationwide survey of in-patients. Br J Psychiatry. 2003;183:50–6. doi: 10.1192/bjp.183.1.50.PubMedCrossRefGoogle Scholar
  47. 47.
    Drummond M. Cost-of-illness studies: a major headache? Pharmacoeconomics. 1992;2(1):1–4.PubMedCrossRefGoogle Scholar
  48. 48.
    Byford S, Torgerson DJ, Raftery J. Economic note: cost of illness studies. BMJ. 2000;320(7245):1335.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.King’s Health Economics (KHE)Institute of Psychiatry, Psychology and Neuroscience at King’s College LondonLondonUK

Personalised recommendations