Schizophrenia is one of the most disabling disorders. The cost of this illness to individuals and society is enormous. But do we really know how much it costs to the society ?
Cost estimates are calculated by multiplying cost per patient with the prevalence of the illness. Prevalence estimates vary widely. A systematic review calculated (Saha et al 2005) life time prevalence as 0.4% and the period prevalence (1–12 months) as 0.33%. cost calculation also involves employment rate of individuals with schizophrenia. This also varies widely. In western societies 12%- 39% of those with schizophrenia are reported as employed. There are various uncertainties around this data as well.
Evensen et al from Oslo report a unique study that sheds light on the costs of schizophrenia. This is a population based study from Norway. It used a top-down design, where data from national registers for the period January 1 to December 31, 2012 were used to (aggregate figures of actual resource consumtption) calculate costs. Direct (treatment and community care) and indirect (ie, social security payments and lost productivity) costs were also taken in to account.Costs related to premature mortality, volunteer and family care, and the criminal justice system were not included.
They used a very comprehensive approach to get all information ( IP care, Op care, GP care, medication use, home care, social benefits ) making this one of the best addressing this issue.
The average 12 month prevalence of schizophrenia was 0.17% for the entire Norwegian population.This would be 0.22% for those aged above 18. Employment rate in general ppulation in teh age group 30-50 is around 80% compared with around 10% in those with schizophrenia. The employment rate (full time and part time) among those of working age was 10.24%–10.5% of the men and 9.8% of the women.
Total national cost associated with schizophrenia is USD 890 million/ year.The average cost per individual with schizophrenia was USD 106,014.00 . One third of total societal cost is due to hospitalisation. 18 % of all hospital days are due to schizophrenia, and 14% of all OP visits are due to schizophrenia . Lost productivity cost accounted for 29% of the total cost.
Studies from UK and Sweden have showed lesser proportion of expenses attributed to IP care ( 8-16%). Norway has more number of beds than others ( 83 beds/ 100,000) compared to around 50 in UK) and this may be a factor.
This is a unique study which adds to the argument that poor mental health is a big economic drain on communities world wide.
Comments: In many countries individuals are left to their own resources leading to impoverishment , debt and early death. In countries like Norway, where society take responsibility for mental health services, greater effort and resources are allocated to improve population mental health, provide most effective service and to research best options. Mental health is a serious matter for such welfare societies.
Summary of the article
Evensen S, Wisløff T, Lystad JU, Bull H, Ueland T, Falkum E. Schizophr Bull. 2016 Mar;42(2):476-83.