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The study estimated an excess societal economic burden of $343.2 billion in 2019 for schizophrenia in the United States, based on a lifetime prevalence of 1.19%. That corresponded to an annual excess cost of $87,856 per person with schizophrenia and an estimated affected population of 3,906,050 people.

Indirect costs were the largest contributor, totaling $251.9 billion and accounting for 73.4% of the total economic burden of schizophrenia in 2019. Excess direct health care costs were $62.3 billion, and excess direct non3health care costs were $35.0 billion.

Caregiving was the single largest cost component, estimated at $112.3 billion in 2019. That equaled $28,761 per person with schizophrenia and accounted for 32.7% of the total excess economic burden.

Excess direct health care costs totaled $62.3 billion and were led by inpatient care at $30.2 billion. Other components were 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.

Yes. Inpatient care was the largest direct health care cost at $30.2 billion, compared with $12.1 billion for pharmacy costs. Outpatient care was also slightly higher than pharmacy costs at $12.9 billion.

Excess direct non3health care costs were estimated at $35.0 billion, or about 10.2% of the total burden. These included $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 Supplemental Security Income and Social Security Disability Insurance.

The study also subtracted $6.0 billion in direct cost offsets related to basic living costs avoided by institutionalized individuals who would otherwise rely on the social safety net.

Mean excess health care costs were highest in commercially insured patients at $19,293 per patient, followed by Medicaid-insured patients at $15,347 and Medicare-insured patients at $11,963. Mean total health care costs were $26,904 for commercially insured patients, $26,095 for Medicaid-insured patients, and $34,391 for Medicare-insured patients.

The authors used a retrospective exact matched cohort design with insurance claims data from IBM Watson Health MarketScan databases covering October 1, 2015, through December 31, 2019. They compared patients with schizophrenia or schizoaffective disorder to matched controls without schizophrenia across Medicaid, commercial insurance, and Medicare populations.

Patients with schizophrenia had to have at least 2 diagnoses of schizophrenia (ICD-10-CM F20) or schizoaffective disorder (F25), at least 12 months of continuous enrollment, and were matched up to 1:3 to controls on variables including age, sex, plan type, and other payer-specific characteristics.

After adjustment for inflation, the study found that the total estimated burden of schizophrenia increased by 100.9% from 2013 to 2019. On a per-patient basis, the burden increased by 78.8%.

The authors also reported that direct health care costs were 50.7% higher than in 2013, direct non3health care costs were 290.4% higher, and indirect costs were 95.7% higher, although they noted that some of these differences reflected methodological changes as well as changes in prevalence and cost inputs.

Yes, but the burden remained very large. In sensitivity analysis using a lifetime prevalence of 0.72%, the schizophrenia population in 2019 was estimated at 2,363,325 and the excess economic burden was estimated at $215.1 billion.

Under that scenario, excess direct health care costs were $37.7 billion, excess direct non3health care costs were $30.8 billion, and excess indirect costs were $152.8 billion.

The authors noted several limitations that could affect the precision and generalizability of the estimate. Schizophrenia prevalence is difficult to estimate, and definitions of schizophrenia were not consistent across all literature sources used for non3health care and indirect costs. The direct health care analysis included both schizophrenia and schizoaffective disorder, which may under- or overestimate the true burden.

They also noted that direct health care costs for undiagnosed schizophrenia were not captured, patients with overlapping insurance eligibility or military coverage were not represented in the claims samples, costs in uninsured patients were estimated using an assumption based on Medicaid cost ratios, and premature mortality estimates depended on the life-year valuation approach used.