OBJECTIVES: Schizophrenia places a heavy burden on individuals and their caregivers, as well as potentially placing a large demand on the healthcare system and its resources. The objective was to understand the cost burden imposed by schizophrenia, and to identify the key drivers of costs. METHODS: We conducted a literature review capturing reviews and recent individual studies on costs of the disease in Europe and US, using Embase and Medline databases. RESULTS: Thirty-six references were included, covering 8 countries (UK, France, Germany, Norway, Canada, US, India and Thailand). Costs described were mainly those related to care settings (hospital or community), pharmacological and non pharmacological therapies, comorbidities and family or caregiver costs. The absolute costs were variable across studies (e.g. from €5,000 to €12,000 per year in England, from $8,000 to $26,000 per year in Canada and from 86,000THB to 146,000 THB in Thailand). This was due primarily to the differences in the national healthcare system, but also to the type of costs included in the analyses. Key drivers of costs included gender (male patients were about 50% more costly), type of medication, and previous psychiatric hospital admission. Costs also increased with severity of the disease. CONCLUSIONS: The burden of schizophrenia is significant regardless of the country; however variable estimates of the burden are available in literature due mainly to the treatment regimens used and the approaches to schizophrenia care (e.g. hospital based versus community-based)  in respective countries. At present, there is a need of a standard method for quantitatively assessing and aggregating the various aspects of the cost of schizophrenia.