OBJECTIVES: This study quantifies excess annual costs associated with schizophrenia patients in the United States in 2002 from a societal perspective. METHODS: Annual direct medical costs associated with schizophrenia were estimated separately for privately (n=1,090) and publicly (Medicaid n=14,074) insured patients based on administrative claims data, including a large private claims database and a State Medicaid database, and compared separately to demographically-geographically matched control samples (1 case: 3 controls). Medicare costs were imputed using the Medicare/Medi-Cal dual eligible patients (n=1491) and published statistics. Excess annual direct non-healthcare costs were estimated for law enforcement, homeless shelters, and research/training related to schizophrenia. Excess annual indirect costs were estimated for four components of productivity loss: unemployment, reduced work place productivity, premature mortality from suicide, and family caregiving using a human capital approach based on market wages. All costs were adjusted to 2002 dollars using the Consumer Price Index and were based on the reported prevalence in the National Comorbidity Survey Replication. RESULTS: The overall US 2002 cost of schizophrenia was estimated to be $62.7 billion, with $22.7 billion excess direct health care cost ($7.0 billion outpatient, $5.0 billion drugs, $2.7 billion inpatient, $8.0 billion long term care). The total direct non-health care excess costs, including living cost offsets, were estimated to be $7.6 billion. The total indirect excess costs were estimated to be $32.4 billion. CONCLUSION: Schizophrenia is a debilitating illness resulting in significant costs. The indirect excess cost due to unemployment is the largest component of overall schizophrenia excess annual costs.