OBJECTIVES: Schizophrenia (SZ) is a chronic mental health disorder characterized by positive and negative symptomology as well as significant disability. SZ routinely disrupts the lives of patients and their caregivers. The economic burden of SZ is substantial, but estimates of indirect and direct costs are variable across patient subpopulations. We conducted a systematic literature review (SLR) of the economic burden of SZ in the US to summarize and identify determinants of costs.

METHODS: Systematic searches were conducted in Medline and Embase to identify observational studies published between 1/1/2008-6/1/2018. References were screened according to SLR best practices. Studies reporting economic burden among US adults with SZ were included in the review. Costs were converted to 2016 USD.

RESULTS: A total of 155 studies were included in the SLR, the majority of which reported health care resource utilization and direct costs. Estimates of the total economic burden of SZ (indirect and direct) varied greatly across studies, with a high estimate of $176.9 billion/year. Indirect costs due to unemployment, work productivity loss, and caregiver burden comprised 75%-81% of the total economic burden of SZ. SZ-related direct costs ranged from $4,136-$75,695 per-patient-per-year with higher direct costs observed in relapsed patients and those with comorbidities. Direct costs were primarily driven by inpatient services, which comprised as much as 51% of all direct costs.

CONCLUSIONS: SZ represents a significant cost burden to patients, caregivers, and health care systems in the US. Indirect costs accounted for a majority of the total cost burden of SZ. Relapse into acute episodes and comorbidities were drivers of direct costs. Results highlight the need for improved disease management strategies that may reduce indirect and direct costs.