The global economic burden of schizophrenia: an umbrella review of systematic reviews and meta-analyses with reconstructed primary-study cost data

Existing studies on the economic impact of schizophrenia are fragmented and vary in methodology, hindering an ample understanding of the total economic burden. To quantify the global economic burden of schizophrenia by synthesizing findings from systematic reviews and meta-analyses, and to assess variations by cost category, world region and income level. We conducted a protocol-driven umbrella review registered on PROSPERO (CRD42024504092). A systematic search of MEDLINE, EMBASE, Cochrane Library, and APA PsycINFO identified reviews reporting annual per-patient monetary cost estimates for schizophrenia. Monetary values were adjusted for inflation and converted to 2024 US dollars. Twenty-six systematic reviews involving 152 primary studies were included. The median annual per-patient total cost of schizophrenia across included primary studies was $33,236 (mean $47,872), with direct costs accounting for $23,126 (medical: $19,543; ancillary: $1,152) and indirect costs for $21,333. Costs were varied by income level: in high-income countries, the median total cost was $34,175, compared to $3,345 in upper-middle-income and $3,452 in lower-middle-income countries. Regional disparities were substantial, with Europe & Central Asia reporting the highest median costs among high-income settings. Data from low- and middle-income regions were limited or absent. Methodological heterogeneity, lack of standardization in cost reporting, and underrepresentation of low-resource settings limit generalizability. The included cost-of-illness estimates indicate that schizophrenia is associated with substantial annual per-patient costs, with hospitalization, long-term care, and productivity losses frequently among the largest reported components. However, the evidence base is heavily weighted toward high-income countries, and limited data from lower-resource settings constrain cross-country comparability. Future research should adopt standardized costing frameworks and expand data collection in underrepresented regions to improve the consistency, transparency, and geographic coverage of economic burden estimates.