U.S. Excess Burden of Schizophrenia in 2002 J Clin Psychiatry 66:9, September 2005 1123 he American Psychiatric Association (APA) Guide- lines 1 define schizophrenia as a chronic and de- Objective: This study quantifies excess annual costs associated with schizophrenia patients in the United States in 2002 from a societal perspective. Method: Annual direct medical costs associ- ated with schizophrenia were estimated separately for privately (N = 1090) and publicly (Medicaid; N = 14,074) insured patients based on administra- tive claims data, including a large private claims database and the California Medicaid program (Medi-Cal) database, and compared separately to demographically/geographically matched control samples (1 case:3 controls). Medicare costs of patients over age 65 years were imputed using the Medicare/Medi-Cal dual-eligible patients (N = 1491) and published statistics. Excess an- nual direct non–health care costs were estimated for law enforcement, homeless shelters, and re- search/training related to schizophrenia. Excess annual indirect costs were estimated for 4 compo- nents of productivity loss: unemployment, re- duced workplace productivity, premature mortal- ity from suicide, and family caregiving using a human capital approach based on market wages. All costs were adjusted to 2002 dollars using the Medical Care Consumer Price Index and were based on the reported prevalence in the National Comorbidity Survey Replication. Results: The overall U.S. 2002 cost of schizo- phrenia was estimated to be $62.7 billion, with $22.7 billion excess direct health care cost ($7.0 billion outpatient, $5.0 billion drugs, $2.8 billion inpatient, $8.0 billion long-term care). The total direct non–health care excess costs, including living cost offsets, were estimated to be $7.6 billion. The total indirect excess costs were estimated to be $32.4 billion. Conclusion: Schizophrenia is a debilitating illness resulting in significant costs. The indirect excess cost due to unemployment is the largest component of overall schizophrenia excess annual costs. (J Clin Psychiatry 2005;66:1122–1129) T bilitating mental illness in which patients often have a diminished capacity for learning, working, self-care, in- terpersonal relationships, and maintaining general living skills. Crown et al. 2 estimate that 40% to 60% of schizo- phrenia patients are likely to suffer from lifelong impair- ments. Kessler et al. 3 state that schizophrenia affects a minimum of 0.5% (range, 0.3%–1.6%) of the U.S. popula- tion, although they note that this survey-based prevalence estimate is a lower bound due to the underrepresentation of schizophrenia patients in epidemiologic surveys. Previous U.S. cost-of-illness studies have documented that schizophrenia is a costly disease. Cost-of-schizophre- nia studies in the early 1990s by Wyatt et al. 4 and Rice and Miller 5 estimated the annual costs of schizophrenia to be $65 billion and $33 billion, respectively. These estimates should be considered as measures of the economic impact of the disease to society, i.e., excess costs of patients with schizophrenia compared to their costs had they never had schizophrenia. The 2 studies’ estimates of total direct costs were similar, in the range of $18 billion to $19 billion. The discrepancy between their total cost estimates arises mainly from differences in estimated indirect costs due to inclusion of different cost components, application of dif- ferent methodologies, and use of different data sources. For example, to estimate lost earnings from premature mortality, Wyatt et al. 4 applied a steady-state methodol- ogy, whereas Rice and Miller 5 projected the earnings for the duration of the patient’s life, had that person not com- mitted suicide, and discounted the results to 1990 values. Received March 14, 2005; accepted June 20, 2005. From Analysis Group, Inc., Boston, Mass. (Drs. Wu and Birnbaum, Mr. Moulis, and Ms. Aggarwal); Eli Lilly and Company, Indianapolis, Ind. (Dr. Shi and Mr. Ball); the Departments of Health System Management and Psychiatry and Neurology, Tulane University, New Orleans, La. (Dr. Shi); and the Department of Health Care Policy, Harvard Medical School, Boston, Mass. (Dr. Kessler). Research was funded by an unrestricted research grant from Eli Lilly and Company, Indianapolis, Ind. Drs. Wu, Birnbaum, and Kessler and Mr. Moulis and Ms. Aggarwal have served as consultants for Lilly. Dr. Shi is no longer an employee of Lilly. Mr. Ball is an employee and stockholder of Lilly. Corresponding author and reprints: Eric Q. Wu, Ph.D., Analysis Group, Inc., 111 Huntington Ave., 10th Floor, Boston, MA 02199 (e-mail: ewu@analysisgroup.com). The Economic Burden of Schizophrenia in the United States in 2002 Eric Q. Wu, Ph.D.; Howard G. Birnbaum, Ph.D.; Lizheng Shi, Ph.D.; Daniel E. Ball, M.B.A.; Ronald C. Kessler, Ph.D.; Matthew Moulis, B.A.; and Jyoti Aggarwal, M.H.S. 1122