Indirect Costs Drive $366B Schizophrenia Burden in US
Key Clinical Summary
- Schizophrenia in the United States imposed an estimated $366.8 billion economic burden in 2024 across health care, housing, justice involvement, and lost productivity.
- $291.8 billion (≈ 80%) of total costs were indirect, driven by unemployment, reduced life expectancy, and caregiver burdens.
- Average per-person cost was $119,436 nationally, with state-level variation (highest in Alaska, lowest in Utah).
A comprehensive economic evaluation published in JAMA Psychiatry reported substantial national and state-level societal costs of schizophrenia in the United States for the 2024 calendar year, estimating a total excess societal cost at $366.8 billion.
Study Findings
The study quantified direct and indirect costs using a prevalence-based, excess-cost model informed by inputs from targeted literature review and analysis of Medical Expenditure Panel Survey data. Based on a prevalence of 1.17% (≈3.07 million adults) nationwide, the observational cost-of-illness model estimated total excess societal costs for adults with schizophrenia spectrum disorders at $366.8 billion in 2024.
Direct costs amounted to approximately $75.0 billion (20% of total), including health care ($36.7 billion), supportive housing and homelessness remediation ($35.2 billion), justice system interactions ($11.9 billion), and disability benefits ($5.1 billion).
Indirect costs were far higher at $291.8 billion (≈ 80%), driven by factors such as nonemployment and reduced wages ($55.4 billion), reduced quality of life ($41.4 billion), shortened life expectancy ($47.5 billion), and extensive caregiver impacts ($165.0 billion), including unpaid caregiving and lost productivity.
Per-adult costs averaged $119,436, with notable state-level variation: Alaska led at $126,225 per person, while Utah was lowest at $110,975.
Clinical Implications
These findings highlight schizophrenia’s multisectoral economic burden beyond direct medical care, emphasizing societal impacts that intersect with employment, housing instability, justice system involvement, and caregiver health. For clinicians and health systems, recognizing the indirect cost drivers — such as unemployment and caregiver burden — underscores the importance of comprehensive care models that extend beyond symptom management.
Routine assessment of social determinants of health, employment supports, and integrated care coordination may mitigate downstream economic and functional burdens. Additionally, the large indirect costs associated with early mortality and quality-of-life reductions reinforce the need for proactive interventions aimed at reducing morbidity and mortality among people living with schizophrenia.
State-level cost variability suggests heterogeneity in care access, local economics, and social service infrastructures, informing targeted resource allocation and policy development. Clinician engagement with policymakers on supportive housing, disability services, and community integration may have both clinical and economic benefits.
Expert Commentary
According to the authors, updated cost estimates incorporating community, institutional, and unhoused populations provide a more complete picture than prior claims-based analyses. These data illuminate how direct care resources and broader societal structures contribute to total burden and can be used to guide prevention, care strategies, and policy decisions to improve outcomes for individuals and families.
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