The Costs of Schizophrenia: A Systematic Review

OBJECTIVES: This systematic review aims to analyze the costs associated with schizophrenia, providing a detailed overview worldwide.

METHODS: A literature search was conducted in PubMed, Scopus, and Web of Science, using search terms related to schizophrenia and economic healthcare costs. After removing duplicates, titles and abstracts were screened, followed by a full-text assessment. Only studies meeting inclusion criteria were included in the final analysis.

RESULTS: Of the 1868 articles identified, only 45 met the inclusion criteria and were included in this systematic review. The results highlight the importance of both direct and indirect costs associated with schizophrenia. Most of the 45 studies evaluated only direct costs. Overall, the average was about $11,213 per patient per year (minimum of $349 and a maximum of $32,920). Hospitalization costs constitute the main factor of these direct costs, with estimates reaching up to $16,245 in some countries. Outpatient and pharmaceutical costs also represent a significant portion of direct costs, with estimates amounting to $11,815 and $6,145, respectively. The studies that evaluated both direct and indirect costs showed that indirect costs were usually higher than direct costs. The main indirect costs evaluated were loss of productivity ($32,141), costs related to crime ($22,342), fiscal losses ($56,707) and impact on caregivers ($22,087). We also found significant variation in costs between countries. The level of direct costs was higher in high-income countries than in upper-middle-income countries, i.e., $32,920 per person per year in the United States compared with $371 in Thailand. Lower-middle-income countries face greater economic challenges (about $349 in Nigeria).

CONCLUSIONS: This systematic review showed significant variations in the costs of schizophrenia between countries, with commonalities such as the importance of indirect costs and hospitalization costs. The critical importance of understanding and managing the economic burden of schizophrenia, allows policymakers to take action to optimize resource management and improve patient care.