Schizophrenia: The Cost of Care

Aliases: schizophrenia

For the theme of economics, it made sense (cents?) to write about the most expensive suite of diseases: mental illnesses. Of these, schizophrenia may be the costliest4. The total overall cost (the cumulative cost, not annual) of schizophrenia in the US in 2002 was estimated to be $62.7 billion, encompassing 2.5% of US healthcare spending3. This astronomical sum is the result of a multitude of causes, the most obvious of which is the large number of people that the illness affects. About 1% of American adults have schizophrenia1; as the US adult population is approximately 241,838,562, this amounts to about 2,418,386 people.

Schizophrenia is chronic, an ailment that persists or recurs throughout life. Because of the early age of onset (most commonly in the late teens or twenties), the illness results in decades of continuous care. The long duration and pervasive social impact of the disease is reflected in the breakdown of the overall cost. While direct health care costs, such as medication and long term care, are high, totaling to approximately $22.7 billion in the US in 2002, the majority of the expense is due to indirect costs (approximately $32.4 billion), with direct non-health care costs, such as living offsets, making up the difference (approximately $7.6 billion)3.

Indirect costs quantify the affect of schizophrenia on society. As it turns out, the single costliest aspect of this illness is not what it demands from the community (i.e. care), but what it withholds. People burdened with schizophrenia are often unable to work, and unemployment, what economists call productivity loss, is the greatest driver behind the rising cost of schizophrenia, both in the US and abroad2,3,4. Of course these facts, like so many of their ilk, are simplistic renderings of a more complex reality. They do not account for the emotional costs incurred by those most affected by schizophrenia: the friends, families and, most importantly, the ill.

schizophrenia
Care: it’s not exactly dollars and cents.

Cause: The underlying causes of schizophrenia remain unclear, but it most likely results from a combination of genetic and environmental factors, meaning the disease requires a genetic predisposition that interacts with the surrounding environment (i.e. prenatal exposure to a virus) to result in illness. Imbalanced brain chemistry, specifically in the neurotransmitters dopamine and glutamate, and abnormal brain development and structure may also play a role in the development of schizophrenia. People are most commonly diagnosed between the ages of 16 and 30 (when symptoms usually develop), and rarely after 45. Men and women are equally susceptible1.

Consequence: People suffering from schizophrenia exhibit three types of symptoms: positive, negative and cognitive. Positive symptoms are behaviors that are not seen in healthy people, and include hallucinations, delusions, and thought and movement disorders. Negative symptoms are more subtle and may be mistaken for depression. They include disruptions to normal emotions and behaviors, such as a flat affect and a lack of pleasure in everyday life. Cognitive symptoms such as poor “working memory” (the ability to use information right after learning it), are even more difficult to identify, and are usually only detected by psychological testing1.

Cure: The treatment of schizophrenia addresses its symptoms (as its causes are not well understood), and relies on antipsychotic medications, which suppress hallucinations and other psychotic symptoms, and psychosocial approaches. Psychosocial treatments include an array of methods, ranging from cognitive and behavioral therapy to social and vocational training1.

References

1. Schizophrenia. National Institute of Mental Health. Web. 1 April 2014.

2. Somaiya, M, S Grover, A Avasthi, & S Chakrabarti. (2014). Changes in cost of treating schizophrenia: Comparison of two studies done a decade apart. Psychiatry Research, 215:547-553.

3. Wu, EG, HG Birnbaum, L Shi, DE Ball, RC Kessler, M Moulis, and J Aggarwal. (2005). The economic burden of schizophrenia in the United States in 2002. Journal of Clinical Psychiatry, 66(9):1122-1129.

4. Zhai, J, X Guo, Min Chen, J Zhao, & Z Su. (2013). An investigation of economic costs of schizophrenia in two areas of China. International Journal of Mental Health Systems, 7:26

Image source: https://momsincharge.wordpress.com/2012/02/