title: The Societal Costs of Schizophrenia in Switzerland.
abstract: BACKGROUND
  Schizophrenia is a severe mental disorder that typically develops in early adulthood and becomes chronic in most cases. The disease is associated with elevated health care utilization, impaired functionality and the loss of life years and quality of life. The prevalence and costs of schizophrenia are not yet known for Switzerland.
  
  
  OBJECTIVE
  This study aims to estimate the prevalence of schizophrenia in Switzerland and to assess its burden on patients, caregivers and society as a whole.
  
  
  METHODS
  A hospital registry was combined with an outpatient physician survey and health insurance claims data to capture all patients living in the northern part of the canton of Zurich. Structured interviews with outpatient physicians were held to obtain information on outpatient care in private practices. Total costs included direct medical and nonmedical costs and lost production. All costs were calculated for the year 2012 from a societal perspective using a prevalence-based bottom-up approach. Intangible costs were expressed as quality-adjusted life years (QALY). Uncertainty and its sources were addressed in univariate and probabilistic sensitivity analyses.
  
  
  RESULTS
  The point prevalence of schizophrenia in Switzerland was estimated at 0.39% of the population. The average costs of schizophrenia in 2012 were EUR 39,408 per patient. Lost production accounted for 64% (EUR 25,108) of the total cost of illness, direct medical costs for 24% (EUR 9,507) and care by relatives or in residential homes for the mentally ill for 12% (EUR 4,793). Inpatient hospital care amounted to EUR 6,242 per year or 66% of direct medical costs.
  
  
  CONCLUSIONS
  The results show the high burden of schizophrenia on patients, caregivers and society. The prevalence estimate can be considered a lower bound because undiagnosed cases were not identified by our empirical strategy. The estimated costs are conservative because the costs of comorbidities were not considered. The strengths of this study are the full coverage of the sample region by a combination of different data sources and the careful evaluation of parameter uncertainty. The main limitation is the small sample size for the assessment of private practice outpatient care.
  The high costs of inpatient hospital care demonstrate the potential benefits of effectively preventing relapses associated with readmissions to inpatient care. Considering the high burden of lost production and the early onset of the disease, programs for reintegration into the labor market have high potential to reduce the costs of schizophrenia. Future research should address the evolution of costs over the disease course. This information would allow for assessing the cost-effectiveness of early detection and interventions that alter disease progression.
authors.forename: Mark
authors.initials: M
authors.lastname: Pletscher
authors.forename: Renato
authors.initials: R
authors.lastname: Mattli
authors.forename: Agnes
authors.initials: A
authors.lastname: von Wyl
authors.forename: Oliver
authors.initials: O
authors.lastname: Reich
authors.affiliation: Winterthur Institute of Health Economics, ZHAW Zurich University of Applied Sciences, Gertrudstrasse 15, CH-8400 Winterthur, Switzerland, simon.wieser@zhaw.ch.
authors.forename: Simon
authors.initials: S
authors.lastname: Wieser
mesh_terms: D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D017281:Cost of Illness; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000191:economics / Q000706:statistics & numerical data; D012042:Registries / Q000706:statistics & numerical data; D012559:Schizophrenia / Q000191:economics* / Q000453:epidemiology*; D013557:Switzerland / Q000453:epidemiology