RESEARCH WEEKLY: The high cost of schizophrenia

(Aug. 9, 2016) New research estimates the direct and indirect cost of schizophrenia to US society in 2013 was $155 billion – $44,773 per individual with the disease. By comparison, major depression affects 6 times as many people but was estimated in 2015 to cost $210.5 billion, only 35% more.

The majority of the economic impact was from the lost work productivity of individuals with the disease and their caregivers: $117 billion. Unemployment was the single biggest contributor to cost impact at $59 billion (37.9% of total).

The second most significant cost impact resulted from the lost productivity of those who took care of individuals with schizophrenia. Martin Cloutier and colleagues reported that time devoted to caregiving by family members increased from 484 hours per year in 2002 to 1,040 in 2013. Total caregiver cost: $52.5 billion or 34% of the total economic impact of schizophrenia.

Closing psychiatric hospital beds – a practice known as “deinstitutionalization”- may have contributed to the cost impact on caregivers, the authors said. “A push for increased family intervention for schizophrenia patients can be beneficial and is recommended by many international clinical guidelines, but this intervention comes at a high emotional and economic price to caregivers.”

The non-health care costs of law enforcement and incarceration were also “significant contributors” to overall cost, according to the study.

Crucial Data for Important Conversations
“The economic burden of schizophrenia in the United States in 2013,” published in the Journal of Clinical Psychiatry, updates or supplies information crucial to the national discussion of mental illness treatment policy, where direct costs and/or cost offsets – cost increases in one category that are offset by cost reductions in another – heavily influence public policy and practice. Among these:

• Criminal justice – $14.3 billion/9.2% of total
  The cost of schizophrenia to law enforcement was estimated at $7 billion in 2013, nearly 5% of the total cost impact of the disease. Incarceration costs were estimated at $3.6 billion, or 2.3% of total cost impact. Judicial, legal and police protection costs totaled $3.5 billion, for an additional 2.3%.
• Suicide – $3.3 billion/2.1% of total
  Only the cost impact of early death by suicide was reported. Similar costs associated with early mortality from co-occurring medical conditions (e.g., heart disease) were not assessed, which means the cost impact of early death is underestimated. 
• Emergency room care – $2.6 billion/1.7% of total 
  The authors said direct health care costs reflected an emphasis on acute care of patients with schizophrenia, including the use of ERs for individuals in crisis.
• Shelters for the homeless – $1.9 billion/1.2% of total 

The cost of schizophrenia had not been reported since 2002, when the economic burden was estimated at $62.7 billion. Calculations in 2013 were made based on the schizophrenia prevalence rate of 1.1% used by the National Mental Health Institute and assumed in all Treatment Advocacy Center studies and analysis. A prevalence rate of 0.5% was assumed by researchers in 2002.

Adjusted for the current prevalence assumptions, population growth, inflation and changed federal policies, the 2013 costs are “consistent” with the earlier ones, the researchers said. The study reflected only the cost differences between an individual with schizophrenia and one without. 

The cost of severe bipolar disorder, which affects more than twice as many people as schizophrenia, was not within the study’s scope.

References:
Cloutier, Martin et al. (June 2016). The economic burden of schizophrenia in the United States in 2013. Journal of Clinical Psychiatry.