La schizophrénie est pour l’OMS la huitième cause de handicap chez les 15 à 44ans. Elle représente un lourd fardeau pour les patients, leurs proches, le système sanitaire, le système social et médicosocial et la société en général. Ses conséquences économiques ont fait l’objet de nombreuses études depuis les années 1970. Son coût pour le système sanitaire représente 1,1 % de la dépense nationale de santé et 12   du produit intérieur brut (PIB) (médianes). Les soins hospitaliers constituent le principal poste de coût pour le système sanitaire (médiane=67 %), mais ils varient beaucoup selon les pays (entre 19 % aux États-Unis et 92 % en Belgique). Le coût des établissements sociaux et médicosociaux équivaut à 2,9   du PIB et le coût de la prise en charge informelle assurée par l’entourage à 2,5   du PIB (médianes). Le coût associé à la perte de productivité est le principal poste de coût de la maladie (médiane=23,5   du PIB). La valeur monétaire de la perte de qualité de vie des patients n’a pas été étudiée. Les méthodes de valorisation diffèrent selon les modes de prise en charge de la maladie et les définitions des systèmes de santé. Les résultats de coût sont donc difficilement transposables en France mais les études analysées dans cette revue fournissent une typologie des postes de coût associés à la schizophrénie ainsi que des ordres de grandeur des montants impliqués.

Schizophrenia represents a major burden for patients, their families, healthcare systems and societies. The objective of this literature review is to document the economic burden of schizophrenia.

The literature search was performed using the MEDLINE-PUBMED database and the following keywords: schizophrenia and cost, burden of disease, qaly or price. The grey literature search was performed using several databases (e.g. Banque de Données en Santé Publique) and the Google Scholar^® web search engine. The studies that met the following criteria were included: published since 1998, written in English or French, studied OECD countries and presented costs data that were given in monetary terms. The costs data identified in the literature were classified into the following five main categories: cost for healthcare system, cost for social and medico-social system (medico-social system is a French specificity), cost for prison and legal systems, cost of informal care given by family, and cost associated with productivity losses. To improve comparability, costs were reported as a percentage of health care expenditures and as a per-ten-thousand of GDP (gross domestic product).

Among the 201 articles identified as potentially relevant to the topic, nine were included in the literature review. Schizophrenia health care costs ranged from four (Ireland) to   of GDP (Spain). Hospital care was the main health care cost driver but ranged from 19 (USA) to 92% (Belgium) demonstrating a great variability in treatment patterns. The costs for social and medico-social system ranged from 1.3 (Korea) to   of GDP (USA) and the costs of informal caregivers ranged from 1.2 (Australia) to   of GDP (Spain). The productivity losses associated with unemployment ranged from 6.2 (Australia) to   of GDP (USA). The productivity losses associated with premature mortality ranged from less than 0.01 (Canada) to   (Ireland). Among others factors, such as targeted population, the choice of valuation method between “Friction costs” and “Human Capital” could account for the heterogeneity of estimates.

Median health care costs of schizophrenia represented 1.1% of total national health care expenditures. Productivity losses associated with morbidity constituted the major cost burden of schizophrenia. Valuation method, costs items, target populations and prevalence rates differed widely from study to study. Furthermore, the burden attributable to loss of quality of life was not estimated in the studies.

Cost-of-illness studies of schizophrenia provide information about its burden on society. The external validity of such studies however is poor and justifies country-specific data collection.