OBJECTIVES: To summarize the magnitude of caregiver burden and indirect costs of schizophrenia in Europe, and to gain a better understanding on the most important factors influencing the variation of these costs.

METHODS: A systematic literature review was conducted in MEDLINE (via Scopus), EMBASE (via Scopus), PsycINFO (Ovid), and databases of health technology assessment (HTA) agencies in March 2017, to identify studies reporting indirect costs and caregiver burden related to patients with schizophrenia.

RESULTS: Eleven studies were included in the qualitative synthesis, after screening 1,630 articles and further reviewing relevant articles that were cited in other published systematic literature reviews. The methodological heterogeneity across studies was considerable. Estimations of annual caregiver burden ranged from €9,590 in the United Kingdom to €30,256-€63,955 in Spain, after inflation adjustments for 2017. Total productivity loss (for patients and caregivers combined) in Italy was estimated between 0.7 days per patient-month between the second and the third follow-up examination of the study, and 3.5 days per patient-month at 90 days before enrollment. The indirect costs from increased utilization of criminal justice services in the United Kingdom ranged from €216 to €397, after inflation adjustments for 2017. Patient groups with higher age were associated with more indirect costs and caregiver burden in Germany, while the presence of negative symptoms of schizophrenia was associated with a 21% increase in productivity loss in Spain.

CONCLUSIONS: Schizophrenia is associated with various types of indirect costs in Europe. Savings can potentially be achieved in these indirect costs by increasing investment in interventions that are targeted at specific symptoms (for example negative symptoms) or specific groups of patients.