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Neuropsychiatric Disease and Treatment 2013:9 787–798
Neuropsychiatric Disease and Treatment
The cost of schizophrenia in Japan
Mitsuhiro Sado1
Ataru Inagaki2
Akihiro Koreki1
Martin Knapp3
Lee Andrew Kissane4
Masaru Mimura1
Kimio Yoshimura4
1Department of Neuropsychiatry, Keio University School of Medicine, 2Center for Clinical Psychopharmacology, Institute of Neuropsychiatry, Tokyo, Japan; 3Department of Social Policy, London School of Economics and Political Science, London, UK; 4Department of Health Policy and Management, Keio University School of Medicine, Tokyo, Japan
Correspondence: Mitsuhiro Sado Department of Neuropsychiatry, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan Tel +81 3 3353 1211 ext 62453 Fax +81 3 5379 0187 Email [email protected]
Introduction: Schizophrenia is a disorder that produces considerable burdens due to its often
relapsing/remitting or chronic longitudinal course. This burden is felt not only by patients them-
selves, but also by their families and health care systems. Although the societal burden caused
by this disorder has been evaluated in several countries, the magnitude of the societal cost of
schizophrenia in Japan has never been estimated. The aim of this study is to clarify the societal
burden of schizophrenia by estimating the cost of schizophrenia in Japan in 2008.
Methods: A human capital approach was adopted to estimate the cost of schizophrenia. The
total cost of schizophrenia was calculated as the sum of the direct, morbidity, and mortality costs.
Schizophrenia was defined as disorders coded as F20.0–F20.9 according to the International
Classification of Diseases-10. The data required to estimate the total cost was collected from
publicly available statistics or previously reported studies.
Results: The total cost of schizophrenia in Japan in 2008 was JPY 2.77 trillion (USD 23.8 billion).
While the direct cost was JPY 0.770 trillion (USD 6.59 billion), the morbidity and mortality
costs were JPY 1.85 trillion (USD 15.8 billion) and JPY 0.155 trillion (USD 1.33 billion),
respectively.
Conclusion: The societal burden caused by schizophrenia is tremendous in Japan, similar to
that in other developed countries where published data exist. Compared with other disorders,
such as depression or anxiety disorders, the direct cost accounted for a relatively high propor-
tion of the total cost. Furthermore, absolute costs arising from unemployment were larger,
while the prevalence rate was smaller, than the corresponding results for depression or anxiety
earnings. Because the ratio of suicides attributed to schizo-
phrenia among all the suicides was somewhat uncertain,
a PSA was performed to clarify the mean cost and its SE.
The mean mortality cost and its SE were JPY 155 billion
(USD 1.33 billion) and JPY 783 million (USD 7 million),
respectively (Table 6).
DiscussionTo our knowledge, this is the first study to evaluate the soci-
etal cost of schizophrenia in Japan. The results showed that
the total cost of schizophrenia was JPY 2.77 trillion (USD
23.7 billion) and the indirect costs constituted the great-
est part of the total cost (72% of the total cost) (Table 7)
(Figure 1). Of note, previous studies also reported that the
indirect costs accounted for a major part of the total costs
(71% in the US in1991;12 52% in the US in 2002;11 52% in
the UK in 2004/200510). However, international comparisons
of the costs of schizophrenia are quite difficult to make,
not only because health and social care systems differ sig-
nificantly internationally, but also because the methodology
of each study varies considerably. Therefore, considerable
caution should be exercised when comparing the results in
this study with those in other countries. Particularly, there
is too much uncertainty around estimates of indirect costs
to allow meaningful comparison. However, less uncertainly
exists in estimates of direct costs, and so here we focus on
comparing only a subset of specific elements of the direct
costs of schizophrenia between countries in which health
care expenditure against gross domestic product is similar in
order to draw some preliminary conclusions. We would like
to make some cautious comparisons using a study reporting
English data by Mangalore and Knapp.10
Because the number of psychiatric beds per capita in
Japan is approximately four times greater than that in the
UK,42 many of those who reside in other facilities outside
hospitals such as care homes and group homes in England
are likely to reside in a hospital in Japan. To account for this
difference, it is more appropriate to compare health care costs
in the study reported above with health and social care, and
institutional costs in aggregate reported by Mangalore and
Knapp for England.10
Mangalore and Knapp indicate that health and social care,
and institutional costs in England are approximately GBP
1.79 billion.10 Considering the population size (128 million
in Japan,35 53 million in England43) and currency exchange
rate (GBP 1 = JPY 183: purchasing power parity),42 this
figure would be equivalent to JPY 0.789 trillion of direct
costs of schizophrenia for Japan, implying that differences
in direct costs between the two countries are surprisingly
small. Furthermore, inpatient costs constituted 80% of the
total health care costs (including the involuntary admission
costs) in Japan in this study (Table 4), while in England the
comparable figure would be 77%, suggesting limited differ-
ences in costs of institutional care for schizophrenia. Given
the major differences between the UK and Japan in how care
for schizophrenia is organized and delivered (inpatient versus
community), the drugs available to treat schizophrenia, and
the rates of comorbidity with illicit drug use, these differences
are surprisingly small.
Comparing the cost of schizophrenia to other mental
disorders in Japan, a report published in 201145 estimated
the costs of depression and anxiety disorders in 2008 using
the same methodology. This 2011 report and the result of our
study reported here, when taken together indicate that for all
three of these mental disorders the indirect costs accounted
for the greater part of the societal cost (72% in schizo-
phrenia; 91% in depression; and 98% in anxiety disorders).
Further, the proportion of each component in the making up
of the indirect costs among these three disorders would appear
Table 4 Inpatient and outpatient costs
Total costs (JPY: million)
Health care costs under health insurance Inpatient costs 602,771 Outpatient costs 148,047Involuntary admission costs* 6184
Note: *Involuntary admission is classified into inpatient cost.
Table 5 Direct costs
Point estimate
(JPY: million)
Health care cost 766,545 Health care care cost under health insurance schema 750,818 Involuntary admission cost 6184 The medical care and supervision act cost 9543Social service cost 3477Total direct cost 770,022
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