Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-02T22:31:57.843Z Has data issue: false hasContentIssue false
  • English
  • Français

Costs of schizophrenia

Published online by Cambridge University Press:  02 January 2018

Martin Knapp
Martin Knapp*
Affiliation:
London School of Economics and Institute of Psychiatry, London
*
Martin Knapp, Institute of Psychiatry, London SE5 8AF
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Schizophrenia is a common and burdensome illness, with implications not only for the health service but for a host of other care agencies – public and private – as well as for patients, families and the wider society.

Method

The paper reviews available UK evidence on the cost of schizophrenia (broadly defined) and on the cost-effectiveness of treatment options and alternative care arrangements. New evidence potentially alters our view of the costs of this illness.

Results

Aggregating the identifiable direct and indirect costs of schizophrenia for England suggests an annual cost of £2.6 billion, but even this sum omits some indirect impacts which cannot currently be costed. Just over half the identified total is accounted for by the direct costs falling to the NHS, local authorities, charities and the criminal justice system. In helping to tackle this cost burden, there is now a body of evidence on cost-effective community care arrangements, antipsychotic drugs and psychological interventions.

Conclusions

Although the costs of schizophrenia are considerable, there are treatments and care arrangements which can reduce this aggregate burden while maintaining or improving effectiveness.

Type
Review Articles
Information
The British Journal of Psychiatry , Volume 171 , Issue 6 , December 1997 , pp. 509 - 518
Copyright
Copyright © 1997 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Addington, D. E., Jones, B., Bloom, D., et al (1993) Reduction of hospital days in chronic schizophrenic patients treated with risperidone: a retrospective study. Clinical Therapeutics, 15, 917–926.Google Scholar
Altchison, K. J. & Kerwin, R. W. (1997) The cost-effectiveness of clozapine: a UK clinic-based study. British Journal of Psychiatry, 171, 125–130.Google Scholar
Albright, P. S., Livingstone, S., Keegan, D. L., et al (1996) Reduction of health care resource utilisation and costs following the use of risperidone for patients with schizophrenia previously treated with standard antipsychotic therapy. Clinical Pharmacoeconomics, 11, 289–299.Google Scholar
Allebeck, P. (1989) Schizophrenia: a life-shortening disease. Schizophrenia Bulletin, 15, 81–89.Google Scholar
Anderson, C., Connelly, J., Johnstone, E. C., et al (1991) Disabilities and circumstances of schizophrenic patients: V. Cause of death. British Journal of Psychiatry, 159 (suppl. 13). 30–33.Google Scholar
Andrews, G., Hall, W., Goldstein, C., et al (1985) The economic costs of schizophrenia. Archives of General Psychiatry, 42, 537–543.Google Scholar
Audini, B., Marks, I. M., Laurrence, R. E., et al (1994) Home-based versus out-patient/in-patient care for people with serious mental illness: phase II of a controlled trial. British Journal of Psychiatry, 165, 204–210.Google Scholar
Beecham, J. K., Knapp, M. R. J. & Allen, C. (1995) Comparative efficiency and equity in community-based care. In The Economic Evaluation of Mental Health Care (ed. Knapp, M. R. J.). pp. 175–194. Aldershot: Arena.Google Scholar
Beecham, J. K., Hallam, A., Knapp, M. R. J., et al (1997) Costing care in the hospital and in the community. In Care in the Community: Illusion or Reality? (ed. Leff, J.). pp. 93–108. Chichester: Wiley.Google Scholar
Birmingham, L., Mason, D. & Grubin, D. (1996) Prevalence of mental disorder in remand prisoners: consecutive case study. British Medical Journal, 313, 1521–1524.Google Scholar
Black, D. W. & Fisher, R. (1992) Mortality in DSM–IIIR schizophrenia. Schizophrenia Research, 7, 109–116.Google Scholar
Boczkowski, J. A., Zekher, A. & DeSanto, N. (1985) Neuroleptic compliance among chronic schizophrenic outpatients: An intervention outcome report. Journal of Consulting and Clinical Psychology, 53, 666–671.Google Scholar
Breier, A., Schreiber, J. L., Dyer, J., et al (1991) National Institute of Mental Health Longitudinal Study of Chronic Schizophrenia. Archives of General Psychiatry, 48, 239–246.Google Scholar
Brooke, D., Taylor, C., Gunn, J., et al (1996) Point prevalence of mental disorder in unconvicted male prisoners in England and Wales. British Medical Journal, 313, 1524–1527.CrossRefGoogle ScholarPubMed
Brooker, C. (1990) A description of clients nursed by CPNs. Journal of Advanced Nursing, 15, 155–166.Google Scholar
Buchanan, A. (1992) A two-year prospective study of treatment compliance in patients with schizophrenia. Psychological Medicine, 22, 787–797.Google Scholar
Burns, T., Beardsmore, A., Bhat, A. V., et al (1993a) A controlled trial of home-based acute psychiatric services. 1: Clinical and social outcome. British Journal of Psychiatry, 163, 49–54.Google Scholar
Burns, T., Raftery, J., Beardsmore, A., et al (1993b) A controlled trial of home-based psychiatric services. 2. Treatment patterns and costs. British Journal of Psychiatry, 163, 55–61.Google Scholar
Cardin, V. A., McGill, C. W. & Falloon, I. R. H. (1986) An economic analysis: costs, benefits and effectiveness. In Family Management of Schizophrenia (ed. Falloon, I. R. H.). Baltimore, MD: Johns Hopkins University Press.Google Scholar
Carone, B. J., Harrow, M. & Wastermeyer, J. F. (1991) Posthospital course and outcome in schizophrenia. Archives of General Psychiatry. 48, 247–253.Google Scholar
Carpenter, W. T., Conley, R. R., Buchanan, R. W., et al (1995) Patient response and resource management: another view of clozapine treatment of schizophrenia. American Journal of Psychiatry, 152, 827–832.Google Scholar
Chisholm, D., Knapp, M. R. J., Astin, J., et al (1997) The mental health residential care study: predicting costs from resident characteristics. British Journal of Psychiatry, 170, 37–42.CrossRefGoogle ScholarPubMed
Creed, F., Mbaya, P., Lancashire, S., et al (1997) Cost effectiveness of day and in-patient psychiatric treatment: results of a randomised controlled trial. British Medical Journal, 314, 1381–1385.Google Scholar
Davies, L. M. & Drummond, M. F. (1993) Assessment of costs and benefits of drug therapy for treatment-resistant schizophrenia in the United Kingdom. British Journal of Psychiatry, 162, 38–42.Google Scholar
Davies, L. M. & Drummond, M. F. (1994) Economics and schizophrenia: the real cost. British Journal of Psychiatry, 165 (suppl. 25), 18–21.CrossRefGoogle Scholar
Davis, J. M., Kane, J. M., Marder, S. R., et al (1993) Dose response of prophylactic antipsychotics. Journal of Clinical Psychiatry, 54 (suppl.), 24–30.Google ScholarPubMed
Donnelly, M., McGilloway, S., Mays, N., et al (1994) Opening New Doors: An Evaluation of Community Care for People Discharged from Psychiatric and Mental Handicap Hospitals. London: HMSO.Google Scholar
Eaton, W. W. (1985) Epidemiology of schizophrenia. Epidemiologic Review, 7, 105–125.CrossRefGoogle ScholarPubMed
Eaton, W. W., Mortensen, P. B., Herrman, H., et al (1992) Long-term course of hospitalization for schizophrenia. Part II: change with passage of time. Schizophrenia Bulletin, 18, 229–239.Google Scholar
Endicott, J., Herz, M. & Gibbon, M. (1978) Brief versus standard hospitalization: the standard costs. American Journal of Psychiatry, 135, 707–712.Google Scholar
Evert, S. M. A. A. & Ament, A. J. H. A. (1995) Costs of schizophrenia in the Netherlands. Schizophrenia Bulletin, 21, 141–153.Google Scholar
Foster, K., Meltzer, H., Gill, B., et al (1996) Adults with a Psychotic Disorder Living in the Community, OPCS Surveys of Psychiatric Morbidity Report 8. London: HMSO.Google Scholar
Frances, A. & Weiden, P. (1987) Promoting compliance with outpatient drug treatment. Hospital and Community Psychiatry, 38, 1158–1160.Google Scholar
Frank, R. G. & Goldman, H. H. (1991) Clozapine's cost benefits (letters). Hospital and Community Psychiatry, 42, 92–93.Google Scholar
Gray, A., Marshall, M., Lockwood, A., et al (1997) Problems in conducting economic evaluations alongside clinical trials: lessons from a study of case management for people with mental disorders. British Journal of Psychiatry, 170, 47–52.CrossRefGoogle ScholarPubMed
Guest, J. F., Hart, W. M., Cookson, R. F., et al (1996) Pharmacoeconomic evaluation of long-term treatment with risperidone for patients with chronic schizophrenia. British Journal of Medical Economics, 10, 59–67.Google Scholar
Gunderson, J. G. & Mosher, L. R. (1975) The cost of schizophrenia. American Journal of Psychiatry, 132, 901–906.Google ScholarPubMed
Hale, T. (1993) Will the new antipsychotics improve the treatment of schizophrenia? British Medical Journal. 307, 749–750.Google Scholar
Hogman, G. (1996) Is Cost a Factor? London: National Schizophrenia Fellowship.Google Scholar
Honigfeld, G. & Patin, J. (1990) A two-year clinical and economic follow-up of patients on clozapine. Hospital and Community Psychiatry, 41, 882–885.Google Scholar
Hummer, M. & Fleischhacker, W. W. (1996) Compliance and outcome in patients treated with antipsychotics. The impact of extrapyramidal syndromes. CNS Drugs, 5 (suppl. 1), 13–20.Google Scholar
Huxley, P. & Kerfoot, M. (1994) A survey of approved social work in England and Wales. British Journal of Social Work, 24, 311–324.Google Scholar
Hyde, C., Bridges, K., Goldberg, D., et al (1987) The evaluation of a hospital ward: a controlled study using modified cost–benefit analysis. British Journal of Psychiatry, 151, 805–812.Google Scholar
Hyde, C., & Harrower-Wilson, C. (1995) Resource consumption in psychiatric intensive care: the cost of aggression. Psychiatric Bulletin, 19, 73–76.Google Scholar
Johnson, S., Ramsey, R., Thornicroft, G., et al (1997) London's Mental Health. London: King's Fund.Google Scholar
Johnstone, E. C., Frith, C. D., Leary, J., et al (1991) Background, method and general description of the sample. British Journal of Psychiatry, 159 (suppl. 13). 43–46.Google Scholar
Jönsson, D. & Wälinder, J. (1995) Cost-effectiveness of clozapine treatment in therapy-refractory schizophrenia. Acta Psychiatrica Scandinavica, 92, 199–201.Google Scholar
Kavanagh, S. & Opit, L. (1994) Estimating the Prevalence of Schizophrenia: A Model for Service Development. Discussion Paper 953. University of Kent at Canterbury: Personal Social Services Research Unit.Google Scholar
Kavanagh, S., Opit, L., Knapp, M. R. J., et al (1995) Schizophrenia: shifting the balance of care. Social Psychiatry and Psychiatric Epidemiology, 30, 206–212.Google Scholar
Kemp, R. & David, A. (1996) Psychological predictors of insight and compliance in psychotic patients. British Journal of Psychiatry, 169, 444–450.Google Scholar
Kemp, R., Hayward, P., Applewhaite, G., et al (1996) Compliance therapy in psychotic patients: randomized control trial. British medical Journal, 312, 345–349.Google Scholar
Kendall, J. & Knapp, M. R. J. (1996) The Voluntary Sector in the UK. Manchester: Manchester University Press.Google Scholar
Kerwin, R. W. (1996) An essay on the new antipsychotics. Psychiatric Bulletin, 20, 23–29.CrossRefGoogle Scholar
King, M. & Nazareth, I. (1996) Community care of patients with schizophrenia: the role of the primary care team. British Journal of General Practice, 46, 231–237.Google Scholar
Kissling, W. (ed.) (1991) Guidelines for Neuroleptic Relapse Prevention in Schizophrenia. Berlin: Springer Verlag.Google Scholar
Kissling, W. & Fleischhacker, W. W. (1992) Optimising prophylactic treatment of schizophrenia by means of treatment standards and compliance improvement. Pharmacopsychiatry, 25, 69–71.Google Scholar
Knapp, M. R. J. (1997) Economics and mental health: a concise European history of demand and supply. In Making Mental Health Services Rational (ed. Tanella, M.). pp. 157–166. Roma: II Pensiero Scientifico.Google Scholar
Knapp, M. R. J., Cambridge, P., Thomason, C., et al (1992) Care in the Community: Challenge and Demonstration. Aldershot: Avebury.Google Scholar
Knapp, M. R. J., Beecham, J. K., Koutsogeorgopoulou, V., et al (1994) Service use and costs of home-based versus hospital-based care for people with serious mental illness. British Journal of Psychiatry, 165, 195–203.Google Scholar
Knapp, M. R. J., Beecham, J. K., Fenyo, A., et al (1995) Community mental health care for former hospital in-patients; predicting costs from needs and diagnoses. British Journal of Psychiatry, 166 (suppl. 27), 10–18.CrossRefGoogle Scholar
Knapp, M. R. J., Chisholm, D., Astin, J., et al (1997) The cost consequences of changing the hospital–community balance: the mental health residential care study. Psychological Medicine, 27, 681–692.Google Scholar
Kulpers, E. (1996) The management of difficult to treat patients with schizophrenia, using non-drug therapies. British Journal of Psychiatry, 169 (suppl. 31), 41–51.CrossRefGoogle Scholar
Leff, J. P., Kuipers, E., Berkowitz, R., et al (1985) A controlled trial of intervention in the families of schizophrenic patients: two year follow-up. British Journal of Psychiatry, 146, 594–600.Google Scholar
Leff, J. P., Trieman, N. & Gooch, C. (1996) Prospective follow-up study of long-stay patients discharged from two psychiatric hospitals. American Journal of Psychiatry, 153, 1318–1324.Google ScholarPubMed
Lelliott, P., Audini, B., Knapp, M. R. J., et al (1996) Mental health residential care: classification of facilities and description of services. British Journal of Psychiatry, 169, 139–147.Google Scholar
Lindström, E., Eriksson, B., Hellgren, A., et al (1995) Efficacy and safety of risperidone in the long-term treatment of patients with schizophrenia. Clinical Therapeutics. 17, 402–412.Google Scholar
McCreadie, R. G. (1992) The Nithsdale schizophrenia surveys. Social Psychiatry and Psychiatric Epidemiology, 27, 40–45.CrossRefGoogle ScholarPubMed
McCreadie, R. G., Leese, M., Tilak-Singh, D., et al (1997) Nithsdale. Nunhead and Norwood: similarities and differences in prevalence of schizophrenia and utilisation of services in rural and urban areas. British Journal of Psychiatry, 170, 31–36.Google Scholar
McCrone, P., Beecham, J. K. & Knapp, M. R. J. (1994) Community psychiatric nurse teams: cost-effectiveness of intensive support versus generic care. British Journal of Psychiatry, 165, 218–221.Google Scholar
McGuire, T. G. (1991) Measuring the economic costs of schizophrenia. Schizophrenia Bulletin, 17, 375–387.Google Scholar
McPhillips, M. A. & Sensky, T. (1997) Coercion, adherence or collaboration? Influences on compliance with medication. In Outcome and Innovation in Psychological Treatment of Schizophrenia (ed. Wykes, T.). Chichester: Wiley, in press.Google Scholar
Mari, J. J. & Streiner, D. (1996) The effects of family intervention on those with schizophrenia. In Schizophrenia Module (eds Adams, C., Anderson, J. & DeJesus Mari, J.). Cochrane Database of Systematic Reviews. London: BMJ Publishing.Google Scholar
Marks, I. M., Connolly, J., Muijen, M., et al (1994) Home-based versus hospital-based care for people with serious mental illness. British Journal of Psychiatry, 165, 179–194.Google Scholar
Mason, P., Harrison, G., Glazebrook, C., et al (1996) The course of schizophrenia over 13 years. British Journal of Psychiatry, 169, 580–586.Google Scholar
Matheson, L. A., Cook, H. M., McKenna, P., et al (1994) Value for money care for patients with schizophrenia. British Journal of Medical Economics. 7, 25–34.Google Scholar
Melzer, D., Hale, A. S., Malik, S. J., et al (1991) Community care for patients with schizophrenia one year after hospital discharge. British Medical Journal, 303, 1023–1026.Google Scholar
Meltzer, H. Y. (1996) Cost-effectiveness of clozapine treatment. Journal of Clinical Psychiatry Monograph Series, 16, 16–17.Google Scholar
Meltzer, H. Y., Cola, P., Way, L., et al (1993) Cost effectiveness of clozapine in neuroleptic-resistant schizophrenia. American Journal of Psychiatry. 150, 1630–1638.Google Scholar
Meltzer, H. Y., Gill, B., Petticrew, M., et al (1995) The Prevalence of Psychiatric Morbidity among Adults Living in Private Households. London: HMSO.Google Scholar
Meltzer, H. Y., Gill, B., Petticrew, M., et al (1996) The Prevalence of Psychiatric Morbidity among Adults Living in Institutions. London: HMSO.Google Scholar
Merson, S., Tyrer, P., Carten, D., et al (1996) The cost of treatment of psychiatric emergencies: a comparison of hospital and community services. Psychological Medicine, 26, 727–734.Google Scholar
Muijen, M., Cooney, M., Strathdee, G., et al (1994) Community psychiatric nurse teams: intensive support versus generic care. British Journal of Psychiatry. 27, 165–169.Google Scholar
National Health Service Executive (1996a) Burden of Disease. Leeds: NHSE.Google Scholar
National Health Service Executive (1996b) 24 Hour Nursed Care for People with Severe and Enduring Mental Illness. Leeds: NHSE.Google Scholar
Nazareth, I., King, M. & Davies, S. (1995) Care of schizophrenia in general practice: the general practitioner and the patient. British Journal of General Practice. 45, 343–347.Google Scholar
Netten, A. & Dennett, J. H. (1996) Unit Costs of Health and Social Care. University of Kent at Canterbury: Personal Social Services Research Unit.Google Scholar
Perring, C., Twigg, J. & Atkin, K. (1990) Families Caring for People Diagnosed as Mentally III: The Literature Examined. London: HMSO.Google Scholar
Philo, G. & Secker, J. (1994) What the papers say. Community Care, 24 February, 14.Google Scholar
Reid, W. H., Mason, M. & Toprac, M. (1994) Savings in hospital bed-days related to treatment with clozapine. Hospital and Community Psychiatry, 45, 261–264.Google Scholar
Revicki, D. A., Luce, B. R., Weschler, J. M., et al (1990) Cost-effectiveness of clozapine for treatment-resistant schizophrenics. Hospital and Community Psychiatry, 41, 850–854.Google Scholar
Rice, D. P., Kelman, S. & Miller, L. S. (1991) Estimates of economic costs of alcohol and drug abuse and mental illness 1985 and 1988. Public Health Reports, 106, 280–291.Google Scholar
Rouillon, F., Dansette, G. Y. & Le Floch, C. (1994) Etude de la prise en charge théraputique des schziphrènes et de son coût. L'Encèphale, 20, 303–309.Google Scholar
Rund, B. R., Moe, L. C., Sollien, T., et al (1994) The psychosis project: an efficiency study of a psychoeducational treatment for schizophrenic adolescents. Acta Psychiatrica Scandinavica, 89, 211–218.Google Scholar
Rupp, A. & Keith, S. J. (1993) The costs of schizophrenia assessing the burden. Psychiatric Clinics of North America, 16, 413–423.Google Scholar
Sayce, L. (1995) Response to violence: a framework for fair treatment. In Psychiatric Patient Violence: Risk and Response (ed. Crichton, J.), pp. 127–150. London: Duckworth.Google Scholar
Schiller, M., Hargreaves, W. A., Essock, S. M., et al (1995) Clozapines cost-effectiveness (letters). American Journal of Psychiatry. 152, 151–152.Google Scholar
Scott, J. E. & Dixon, L. B. (1995a) Assertive community treatment and case management for schizophrenia. Schizophrenia Bulletin, 21, 657–668.Google Scholar
Scott, J. E. & Dixon, L. B. (1995b) Psychological interventions for schizophrenia. Schizophrenia Bulletin, 21, 621–630.CrossRefGoogle ScholarPubMed
Sheldon, T. (1996) Problems of using modelling in the economic evaluation of health care. Health Economics, 5, 1–12.Google Scholar
Shepherd, M., Watt, D., Falloon, I., et al (1989) The natural history of schizophrenia: a five year follow-up study of outcome and prediction in a representative sample of schizophrenics. Psychological Medicine monograph, 15, 1–44.Google Scholar
Smith, K., Shah, A., Wright, K., et al (1995) The prevalence and costs of psychiatric disorders and learning disabilities. British Journal of Psychiatry, 166, 9–18.Google Scholar
Steering Committee of the Confidential Inquiry into Homicides and Suicides by Mentally IN People (1996) Report of the Confidential Inquiry into Homicides and Suicides by Mentally III People. London: Royal College of Psychiatrists.Google Scholar
Stilwell, J. (1981) Mental health: shifting the balance of care. Public Money, 1, 31–34.Google Scholar
Szmulker, G. (1996) From family ‘burden’ to caregiver. Psychiatric Bulletin, 20, 449–451.Google Scholar
Tarrier, N., Lowson, K. & Barrowclough, C. (1991) Some aspects of family interventions in schizophrenia. II. Financial considerations. British Journal of Psychiatry, 159, 481–484.Google Scholar
Terkelsen, K. G. & Grosser, R. C. (1990) Estimating clozapine's cost to the nation. Hospital and Community Psychiatry. 41, 863–869.Google Scholar
Trieman, N. & Leff, J. (1996) The most difficult to place long-stay psychiatric in-patients: outcome one year after relocation. British Journal of Psychiatry, 169, 289–292.Google Scholar
Tyrerk, P., Morgan, J., Van Horn, E., et al (1995) A randomised controlled study of close monitoring of vulnerable psychiatry patients. Lancet, 345, 756–759.Google Scholar
Tyrer, P., Evans, K., Gandhi, N., et al (1997) A randomised controlled trial of two models of care for discharged patients: no advantage of better community care with insufficient hospital beds. British Medical Journal, in press.Google Scholar
Van Putten, T. (1974) Why do schizophrenic patients refuse to take their drugs? Archives of General Psychiatry, 31, 67–72.Google Scholar
Watt, D. C., Katz, K. & Shepherd, M. (1983) The natural history of schizophrenia: a five-year prospective follow-up of a representative sample of schizophrenics by means of a standardized clinical and social assessment. Psychological Medicine. 13, 663–670.Google Scholar
Weiden, P. J. & Olfson, M. (1995) Cost of relapse in schizophrenia. Schizophrenia Bulletin, 21, 419–429.Google Scholar
Weisbrod, B., Test, M. & Stein, I. (1980) An alternative to mental hospital treatment. 2. Economic cost-benefit analysis. Archives of General Psychiatry. 37, 400–405.Google Scholar
White, E. (1991) The Third Quinquennial National Community Psychiatric Nursing Survey University of Manchester.Google Scholar
Wolff, G. (1997) Attitudes of the media and the public. In Care in the Community: Illusion or Reality? (ed.Leff, J.), pp. 145–163. Chichester: Wiley.Google Scholar
Xiong, W., Phillips, M. R., Hu, X., et al (1994) Family-based intervention for schizophrenic patients in China; a randomised controlled trial. British Journal of Psychiatry, 165, 239–247.CrossRefGoogle Scholar
Young, J. L., Zanana, H. V. & Shepter, L. (1986) Medication non-compliance in schizophrenia: codification and update. Bulletin of the American Academy of Psychiatric Law. 14, 105–122.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.