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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.

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  1. 1.

    Saha S, Chant D, Welham J, McGrath J. A systematic review of the prevalence of schizophrenia. PLoS Med. 2005;2(5):e141.

    PubMed  PubMed Central  Article  Google 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.

    PubMed  Article  Google 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.

    CAS  PubMed  Article  Google Scholar 

  5. 5.

    Mangalore R, Knapp M. Cost of schizophrenia in England. J Ment Health Policy Econ. 2007;10(1):23–41.

    PubMed  Google Scholar 

  6. 6.

    Rice DP. Cost of illness studies: what is good about them? Injury Prev. 2000;6(3):177–9.

    CAS  Article  Google 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.

  8. 8.

    Larg A, Moss JR. Cost-of-illness studies: a guide to critical evaluation. Pharmacoeconomics. 2011;29(8):653–71.

    PubMed  Article  Google 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; 1997

  10. 10.

    Gold M. Panel on cost-effectiveness in health and medicine. Med Care. 1996;34(12 Suppl):DS197–199.

  11. 11.

    Sindelar J. Social costs of alcohol. J Drug Issues. 1998;28(3):763–80.

    Article  Google 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.

    PubMed  Article  Google 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.

  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.

    CAS  PubMed  Article  Google Scholar 

  15. 15.

    Gold MR. Cost-effectiveness in health and medicine. Oxford: Oxford University Press; 1996.

  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.

    PubMed  PubMed Central  Article  Google 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.

    Article  Google Scholar 

  18. 18.

    Andlin-Sobocki P, Rossler W. Cost of psychotic disorders in Europe. Eur J Neurol. 2005;12(Suppl 1):74–7.

    PubMed  Article  Google 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.

    CAS  Google Scholar 

  20. 20.

    Knapp M, Mangalore R, Simon J. The global costs of schizophrenia. Schizophr Bull. 2004;30(2):279–93.

    PubMed  Article  Google Scholar 

  21. 21.

    Neil AL, Lewin TJ, Carr VJ. Allocation of resources and psychosis. Aust N Z J Psychiatry. 2003;37(1):15–23.

    PubMed  Article  Google 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.

    PubMed  Google 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.

    Article  Google Scholar 

  26. 26.

    Rice DP. The economic impact of schizophrenia. J Clin Psychiatry. 1999;60(suppl. 1):4–6.

    PubMed  Google 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.

  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.

    PubMed  Google 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.

    PubMed  Article  Google 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.

    Article  Google 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.

    Article  Google 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.

    PubMed  Google 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.

    CAS  PubMed  Article  Google 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.

    CAS  PubMed  Google 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.

    CAS  PubMed  Article  Google Scholar 

  37. 37.

    Langley-Hawthorne C. Modeling the lifetime costs of treating schizophrenia in Australia. Clin Ther. 1997;19(6):1470–95.

  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.

    PubMed  Article  Google 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.

    PubMed  Google 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.

    PubMed  PubMed Central  Article  Google 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.

    PubMed  PubMed Central  Article  Google 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: 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.

    CAS  PubMed  Google 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.

    PubMed  PubMed Central  Article  Google 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.

    PubMed  Article  Google Scholar 

  47. 47.

    Drummond M. Cost-of-illness studies: a major headache? Pharmacoeconomics. 1992;2(1):1–4.

    CAS  PubMed  Article  Google Scholar 

  48. 48.

    Byford S, Torgerson DJ, Raftery J. Economic note: cost of illness studies. BMJ. 2000;320(7245):1335.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

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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.

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Correspondence to Huajie Jin.

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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.

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Jin, H., Mosweu, I. The Societal Cost of Schizophrenia: A Systematic Review. PharmacoEconomics 35, 25–42 (2017).

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  • Schizophrenia
  • Gross Domestic Product
  • Productivity Loss
  • Schizophrenia Patient
  • Societal Cost