CLINICAL HANDBOOK OF SCHIZOPHRENIA

CHAPTER 48THE ECONOMICSOF SCHIZOPHRENIAMIHAIL SAMNALIEVROBIN E. CLARKAlthough schizophrenia is a relatively rare condition, it has a broad-ranging economicimpact on individuals, families, and societies. Disability associated with schizophreniaimpairs earning power for individuals with the illness, and often places increased costsand caregiving demands on family members. Treatment is expensive, and lifetime costsexceed those of many other chronic conditions. Private insurance coverage is often inadequate,and a high proportion of care is covered by publicly financed programs. Healthcare financing has a profound impact on access to effective treatment. Over the past decade,increasing attention has been given to studying the cost-effectiveness of varioustreatments in an attempt to use scarce health care dollars most efficiently and effectively.In this chapter, we address the economic aspects of schizophrenia. We begin by discussingprevalence and costs at the societal level, then how those costs are distributed tovarious payers. Next, we review current knowledge about the cost and effectiveness oftreatment. How health care financing affects the accessibility and efficiency of treatmentis the final topic in our discussion.COSTS OF THE ILLNESSPrevalence and BurdenSchizophrenia affects at least 24 million people worldwide and 2.5 million, or about 1%of the population, in the United States. The global burden of the illness is disproportionatelyhigh compared to other mental disorders, because it affects people in the most productiveperiod of their lives, may cause lifetime disability, and requires expensive treatmentand long-term involvement of caregivers. Schizophrenia is listed by the WorldHealth Organization (WHO) among the top 10 leading causes of disability worldwideand the second largest contributor to the overall burden of disease, after cardiovasculardiseases. The substantial economic burden of schizophrenia stems from direct costsincurred for its treatment in the health care system, and a wide range of indirect costs, in-507