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Costs of schizophrenia

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The economic impact of serious conditions such as schizophrenia is felt widely. The impact on overall health care budgets can be as much as 3% of the total, but there are also other costs, especially those associated with lost productivity, as typically only about one-fifth of all people with schizophrenia are able to find paid work. Decisions about optimal interventions for schizophrenia need to take account of these wide costs alongside the equally wide range of potential outcomes (not just symptom effects, but impacts on personal functioning, social interaction, employment, family relations, and quality of life). Antipsychotics are at the heart of treatment. A fundamental question for those responsible for purchasing medications is whether it is worth paying the inevitably higher prices. Opinion remains divided on this cost-effectiveness question: some studies have concluded that the second-generation antipsychotics are more cost-effective than first-generation medications, but two publicly funded studies (CATIE in the USA and CUtLASS in the UK) have reached the opposite conclusion. Outside the medication field there are fewer economic evaluations of schizophrenia interventions. Cognitive remediation therapy has been shown to produce significant improvements in memory among people with schizophrenia and cognitive deficits. There is also evidence that these improvements were achieved at no additional cost. Regarding service interventions, much attention is now focused on the individual placement and support model, which can improve access to work for people with psychotic illnesses, without any observable corresponding clinical deterioration. Again there is evidence of cost-effectiveness.

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