Clinical Summary: The Economic Burden of Schizophrenia in the United States
For patients with schizophrenia, the clinical burden extends well beyond symptoms and hospital use to unemployment, caregiving demands, premature mortality, homelessness, and involvement with social and legal systems. This analysis shows that in 2019 the largest costs were outside routine medical care, underscoring why psychiatrists should view effective management as important not only for symptom control but also for reducing family and societal burden.
Key Findings
- Given a prevalence estimate of 1.19%, the schizophrenia population in the US in 2019 was estimated to be 3,906,050, contributing to an excess economic burden of $343.2 billion, which corresponded to an annual excess cost per person with schizophrenia of $87,856.
- Excess indirect costs were $251.9 billion ($64,479 per person with schizophrenia) and accounted for 73.4% of the total economic burden; caregiving alone contributed $112.3 billion ($28,761 per person with schizophrenia) and 32.7% of the total excess costs.
- Excess direct health care costs were $62.3 billion ($15,957 per person with schizophrenia), including inpatient care at $30.2 billion, outpatient care at $12.9 billion, pharmacy at $12.1 billion, emergency department visits at $5.6 billion, long-term care at $1.5 billion, and other medical services at $120.6 million.
- Excess direct non–health care costs were $35.0 billion, including $26.1 billion in law enforcement costs, $2.1 billion in homeless shelter costs, $263.0 million in research and training costs, and $6.5 billion related to SSI and SSDI; direct cost offsets of $6.0 billion were subtracted from direct non–health care costs.
- Compared with the 2013 estimate and after adjusting for inflation, the total estimated burden doubled (+100.9%) between 2013 and 2019; in sensitivity analysis using a lifetime prevalence rate of 0.72%, the schizophrenia population was estimated to be 2,363,325 with an excess economic burden of $215.1 billion.
Schizophrenia imposed an estimated $343.2 billion excess societal burden in the US in 2019, with most costs driven by indirect effects rather than direct medical spending. In practice, preventing functional decline, hospitalization, and caregiver strain is central to reducing the real-world burden of illness.
Practice Implications
- Look beyond medication and visit costs when discussing treatment value: indirect costs were $251.9 billion and caregiving alone was $112.3 billion, so interventions that improve functioning and reduce caregiver time have major practical importance.
- Prioritize relapse prevention and hospitalization reduction, as inpatient care was the largest direct health care component at $30.2 billion, exceeding pharmacy costs of $12.1 billion and outpatient costs of $12.9 billion.
- Assess caregiver burden routinely in schizophrenia care, since caregiving accounted for 32.7% of the total economic burden and was the single largest cost component.
- Coordinate with social services and disability resources when planning care, because direct non–health care costs included $26.1 billion in law enforcement costs and $6.5 billion related to SSI and SSDI.
