[The cost of schizophrenia: a literature review].
BACKGROUND
Schizophrenia represents a major burden for patients, their families, healthcare systems and societies. The objective of this literature review is to document the economic burden of schizophrenia.


METHODS
The literature search was performed using the MEDLINE-PUBMED database and the following keywords: schizophrenia and cost, burden of disease, qaly or price. The grey literature search was performed using several databases (e.g. Banque de Données en Santé Publique) and the Google Scholar(®) web search engine. The studies that met the following criteria were included: published since 1998, written in English or French, studied OECD countries and presented costs data that were given in monetary terms. The costs data identified in the literature were classified into the following five main categories: cost for healthcare system, cost for social and medico-social system (medico-social system is a French specificity), cost for prison and legal systems, cost of informal care given by family, and cost associated with productivity losses. To improve comparability, costs were reported as a percentage of health care expenditures and as a per-ten-thousand of GDP (gross domestic product).


RESULTS
Among the 201 articles identified as potentially relevant to the topic, nine were included in the literature review. Schizophrenia health care costs ranged from four (Ireland) to 140000 of GDP (Spain). Hospital care was the main health care cost driver but ranged from 19 (USA) to 92% (Belgium) demonstrating a great variability in treatment patterns. The costs for social and medico-social system ranged from 1.3 (Korea) to 13.80000 of GDP (USA) and the costs of informal caregivers ranged from 1.2 (Australia) to 12.70000 of GDP (Spain). The productivity losses associated with unemployment ranged from 6.2 (Australia) to 21.30000 of GDP (USA). The productivity losses associated with premature mortality ranged from less than 0.01 (Canada) to 3.850000 (Ireland). Among others factors, such as targeted population, the choice of valuation method between "Friction costs" and "Human Capital" could account for the heterogeneity of estimates.


CONCLUSIONS
Median health care costs of schizophrenia represented 1.1% of total national health care expenditures. Productivity losses associated with morbidity constituted the major cost burden of schizophrenia. Valuation method, costs items, target populations and prevalence rates differed widely from study to study. Furthermore, the burden attributable to loss of quality of life was not estimated in the studies.


CONCLUSIONS
Cost-of-illness studies of schizophrenia provide information about its burden on society. The external validity of such studies however is poor and justifies country-specific data collection.
URC Eco (unité de recherche clinique spécialisée en économie de la santé), Hôtel Dieu, AP-HP, 1, place du Parvis-Notre-Dame, 75005 Paris, France. nathanael.charrier@urc-eco.fr
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Chevreul
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Durand-Zaleski
D000293:Adolescent; D000328:Adult; D017028:Caregivers / Q000191:economics; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006701:Home Nursing / Q000191:economics; D006801:Humans; D009313:National Health Programs / Q000191:economics*; D011330:Prisons / Q000191:economics; D019057:Quality-Adjusted Life Years; D012559:Schizophrenia / Q000191:economics* / Q000453:epidemiology; D014478:Unemployment / Q000706:statistics & numerical data; D055815:Young Adult