The global cost of schizophrenia: a health economic modelling study

Schizophrenia is a chronic psychiatric disorder that leads to substantial disability, impaired quality of life, and reduced life expectancy. In addition to its profound impact on affected individuals, the disorder places a considerable financial burden on health care systems, caregivers, and society. Although the cost of schizophrenia has been studied in several individual countries, comprehensive global estimates across multiple cost categories remain scarce. This study aimed to estimate the global socioeconomic burden of schizophrenia using health economic modelling.

We conducted a prevalence-based cost-of-illness analysis for 204 countries in 2019, focusing on adults aged 20 years and older. Data on direct (medical and nonmedical), indirect (productivity losses), and informal (nonprofessional, unpaid) care costs were systematically retrieved through a PubMed-based literature search covering records published between 02/2010 and 04/2023. Extracted per-patient costs were standardized to 2019 purchasing power parity (PPP) USD, and missing data were imputed using a stratification approach based on four gross national income (GNI) groups. Costs were scaled to the national level by multiplying the per-patient costs by country-specific prevalence estimates from the Global Burden of Disease Study. Costs were additionally expressed as a proportion of gross domestic product (GDP). To ensure data validity from a clinical perspective, all estimates were scrutinized by a panel of psychiatry experts.

An estimated 22.1 million adults were living with schizophrenia in 2019 (0.39% prevalence). Total economic costs across upper-middle, lower-middle, and high-income regions reached $243.2 billion (PPP), with direct costs representing 47%, indirect costs 29%, and informal care costs 24%. Upper-middle-income countries bore the greatest burden relative to GDP, whereas high-income countries had the highest per-patient and national costs.

This study provides the most comprehensive global assessment to date of the economic burden of schizophrenia. Per-patient costs were identified as the main driver of the absolute global burden, underscoring the importance of effective disease management strategies. Policy-makers and other stakeholders should prioritize interventions that enhance patient functioning and societal participation.