Looking beyond the symptoms: What is the economic burden of schizophrenia?
Schizophrenia is associated with a substantial economic burden that extends far beyond its clinical symptoms. Read the article below to learn more about the drivers of this burden and how effective antipsychotic treatment may help to reduce the burden.
Schizophrenia spectrum disorders (SSDs) are chronic, disabling conditions that are associated with a 10–20 year reduced life expectancy compared with the general population.1 While the clinical burden of this disorder is well recognised, the impact of schizophrenia extends far beyond symptoms. Schizophrenia places a disproportionately large and growing economic burden on healthcare systems, despite its relatively low prevalence compared with other mental and physical disorders.2 In high-income countries, it has been estimated that 1.5–3% of total healthcare expenditure, and up to 22% of mental health expenditure is related to schizophrenia.2 This economic burden is driven by both direct healthcare costs and indirect costs, related to unemployment, disability, premature mortality and efforts/involvement of informal caregivers.3
The economic burden of schizophrenia in Europe
Real-world evidence from Italy estimated that the mean annual cost of mental health services use per patient with SSD increased from €25,000 in 2018 to €41,290 in 2022.2,4 Higher costs were observed among individuals with worse psychosocial functioning, rather than worse clinical presentation.2 Unsurprisingly, an earlier age of onset was also associated with higher costs, owing to the longer duration of reliance on mental health services across the lifetime of these individuals.2
Another real-world evidence study in Italy indicated that hospital and residential services account for >80% of direct healthcare costs, while psychopharmacological treatments represent a smaller proportion of total expenditure (10%).3 When considering indirect costs, the loss of productivity both for the individual and their caregiver, as well as a reliance on disability pensions were identified as major contributors.3 These trends highlight that the economic burden of schizophrenia is driven primarily by healthcare service use and implications of the disorder on employment, rather than medication costs alone.2,3
The link between relapse, non-adherence and the economic burden
When considering the direct costs of schizophrenia, it is important to note that relapse serves a central role in driving healthcare resource utilisation.3,5 Poor adherence to antipsychotic treatment has been strongly associated with relapse, frequently leading to hospital or residential facility readmission and impaired quality of life, further driving healthcare costs.6 Given that 56–60% of patients do not adhere to medication recommendations and resulting relapse rates range from 75–90%, improving medication adherence and reducing relapse rates may help lessen the economic burden associated with this disorder.5
Can antipsychotic treatment ease the economic burden?
Although medications represent a relatively small proportion of direct costs, effective antipsychotic treatment has the potential to reduce other downstream costs through increasing adherence, preventing relapse and minimising hospitalisation.2,3
Despite remaining the gold standard treatment in schizophrenia, oral antipsychotics are associated with high medication non-adherence, which in turn increases the risk of relapse.7 The use of long-acting injectable (LAI) antipsychotics may serve as a strategy to reduce the economic burden of schizophrenia, particularly when considering costs related to relapse.7 Evidence indicates that LAI antipsychotics are associated with 47% fewer hospitalisations, and 44% fewer suicide attempts compared with oral therapy.8 LAIs also require less frequent dosing than oral therapies; however, because they must be administered by healthcare professionals, treatment depends on patients attending healthcare facilities to receive their injections.7 The challenges of this are reflected in real-world engagement rate data, suggesting that 60–85% of patients do not attend treatment appointments and discontinue therapy, which often leads to relapse.7
Looking to the future: Reducing the economic burden
The economic burden of schizophrenia in Europe is growing.2 Strategies to support early treatment and intervention, medication adherence, and improvements in psychosocial functioning and symptom control may help to reduce the economic burden of schizophrenia.2,3
Imre A, Mészáros A, Németh B, et al. The global economic burden of schizophrenia: An umbrella review of systematic reviews and meta-analyses. Health Econ Rev 2026;16: 56.
Pinton IC, Nibbio G, Bertoni L, Cicale A, Necchini N, et al. The economic burden of schizophrenia spectrum disorders: Clinical and functional correlates and predictors of direct costs. A retrospective longitudinal study. Psychiatry Res 2024;342:116240.
Marcellusi A, Fabiano G, Viti R, Morel PCF, Nicolo G, et al. Economic burden of schizophrenia in Italy: A probabilistic cost of illness analysis. BMJ Open 2018;8:e018359.
Latorre V, Petruzzelli AM, Uva AE, Ranaudo C, Semisa D. Unveiling the actual cost of schizophrenia: An activity-based costing (ABC) approach. Int J Health Plann Manage 2022;37:1366–1380.
Mohammed F, Geda B, Yadeta TA, Dessie Y. Antipsychotic medication non-adherence and factors associated among patients with schizophrenia in Eastern Ethiopia. BMC Psychiatry 2024;24:108.
Niolu C, Bianciardi E, Di Lorenzo G, et al. Enhancing adherence, subjective well-being and quality of life in patients with schizophrenia: Which role for long-acting risperidone? Ther Adv Psychopharmacol 2015;5:278–288.
Hodson N, Majid M, Vlaev I, Singh S. Financial incentives and long-acting injectable antipsychotics engagement: Community mental health professionals’ perspectives. BMC Psychiatry 2025;25:791.
Wei Y, Yan VCK, Kang W, et al. Association of long-acting injectable antipsychotics and oral antipsychotics with disease relapse, health care use, and adverse events among people with schizophrenia. JAMA Netw Open 2022;5:e2224163.
