Estimating the direct and indirect costs for community-dwelling patients with schizophrenia

Aim To estimate the schizophrenia-related direct and indirect costs for community-dwelling Americans sampled in the Medical Expenditure Panel Survey (MEPS) from the societal perspective. Methods Patients diagnosed with a schizophrenic disorder (International Classification of Disease 9th Revision (ICD-9) code 295) or other non- organic psychoses ( ICD-9 code 298) between 1 January 2005 and 31 December 2008 were identified from the MEPS database. The following categories were included in calculating the schizophrenia-related direct medical costs: inpatient hospitalizations, prescription medications and hospital outpatient, emergency department, physician office, and home healthcare visits. The indirect costs were calculated using the human capital approach and included lost productivity due to missed work, reduced employment, premature death and caregivers' costs. To account for the complex multistage sampling design of the MEPS, all statistical analyses were conducted using the survey procedure of SAS version 9.2. Results We identified 348 patients who represent 3.03 million community-dwelling schizophrenia patients in the USA between 2005 and 2008. The estimated direct cost from 2005-2008 was US$ 17.1 billion, or approximately US$ 4 billion per year, with a mean annual cost per patient of US$ 5984. The indirect costs over the same 4-year period amounted to US$ 74.74 billion, or approximately US$ 18.68 billion per year, with a mean annual cost per patient of US$ 24 664. Assuming equal utilization each year, the annual total costs were approximately US$ 23 billion. Discussion The financial burden imposed by schizophrenia was disproportionately high. The mean annual prevalence of schizophrenia in the community was about 0.25% while the annual costs were about US$ 23 billion.