Objectives: To systematically review and synthesize evidence on the economic burden of schizophrenia across countries, focusing on direct and indirect costs.

Methods: A systematic literature review was conducted to identify studies reporting the economic burden of schizophrenia. The analysis included studies that reported direct costs (e.g., healthcare expenses) and indirect costs (e.g., productivity losses). Searches were conducted across major databases (Medline, Cochrane Library, PubMed) and grey literature, adhering to PRISMA guidelines. Full-text economic burden studies published from 1990 to 2024 were screened and extracted. A total of 34 studies met the inclusion criteria and were analyzed.

Results: The included studies spanned 25 countries with diverse healthcare systems and income levels. Per-patient annual direct costs varied widely, ranging from approximately $800-$1,500 in lower-income settings to €10,000-€20,000 in high-income countries. Hospitalizations, long-term care, and pharmacotherapy were major cost drivers. At the national level, annual direct costs ranged from €100 million to over €4 billion, depending on population size and service utilization. Indirect costs—reported in 70% of studies—included productivity losses, caregiver burden, early retirement, and social care. These typically ranged from $1,200 to $15,000 per patient annually and often exceeded direct medical costs. In many studies, indirect costs represented 50-70% of the total burden. Although methodologies varied, a consistent pattern emerged showing schizophrenia imposes a significant and sustained financial impact on health systems and society. Notably, several studies reported a decreasing trend in direct costs over time, mainly due to reduced hospitalization, expanded community-based care, and increased use of long-acting injectable antipsychotics.

Conclusions: Schizophrenia is associated with a substantial economic burden worldwide. While direct costs are considerable, indirect costs frequently exceed them. Addressing both clinical and functional outcomes through integrated care strategies may help reduce the long-term societal and financial burden of the disorder.