Cost of schizophrenia in England.

BACKGROUND: Despite the wide-ranging financial and social burdens associated with schizophrenia, there have been few cost-of-illness studies of this illness in the UK.

AIM OF THE STUDY: To provide up-to-date, prevalence based estimate of all costs associated with schizophrenia for England.

METHODS: A bottom-up approach was adopted. Separate cost estimates were made for people living in private households, institutions, prisons and for those who are homeless. The costs included related to: health and social care, informal care, private expenditures, lost productivity, premature mortality, criminal justice services and other public expenditures such as those by the social security system. Data came from many sources, including the UK-SCAP (Schizophrenia Care and Assessment Program) survey, Psychiatric Morbidity Surveys, Department of Health and government publications.

RESULTS: The estimated total societal cost of schizophrenia was 6.7 billion pounds in 2004/05. The direct cost of treatment and care that falls on the public purse was about 2 billion pounds; the burden of indirect costs to the society was huge, amounting to nearly 4.7 billion pounds. Cost of informal care and private expenditures borne by families was 615 million pounds. The cost of lost productivity due to unemployment, absence from work and premature mortality of patients was 3.4 billion pounds. The cost of lost productivity of carers was 32 million pounds. Estimated cost to the criminal justice system was about 1 million pounds. It is estimated that about 570 million pounds will be paid out in benefit payments and the cost of administration associated with this is about 14 million pounds.

DISCUSSION: It is difficult to compare estimates from previous cost-of-illness studies due to differences in the methods, scope of analyses and the range of costs covered. Costs estimated in this study are detailed, cover a comprehensive list of relevant items and allow for different levels of disaggregation. The main limitation of the study is that data came from a variety of secondary sources and some official data publicly available was not the latest.

IMPLICATIONS FOR HEALTH CARE PROVISION: Schizophrenia continues to be a high cost illness because of the range of health needs that people have. Despite the shifting balance of care away from hospital-based care, the health care costs of treating and supporting people with schizophrenia remain high.

IMPLICATIONS FOR HEALTH POLICIES: Decision-makers need to recognise the breadth of economic impacts, well beyond the health system as conventionally defined. For example, as nearly 80% of schizophrenia patients remain unemployed, the cost of lost productivity is especially large.

IMPLICATIONS FOR FURTHER RESEARCH: Better measurement of criminal justice services costs, private expenditures borne by families and valuation of lost quality of life could improve the estimates further.