National and State Societal Costs of Schizophrenia in the US in 2024

Importance: Schizophrenia imposes a substantial burden on individuals and society. Population-specific cost estimates are essential to inform evidence-based policy, allocate resources, and support recovery-focused care that improves outcomes. Objective: To estimate national and state-level burden of schizophrenia to inform population-specific care and services in the US in 2024. Design, Setting, and Participants: This was an observational prevalence-based cost-of-illness model estimating total excess direct medical, direct nonmedical, and indirect costs of schizophrenia by combining inputs from a targeted literature review and an analysis of Medical Expenditure Panel Survey data, adjusted to 2024 US dollars. The setting included independent households, supportive housing, long-term care and skilled nursing facilities, unhoused settings, and prisons and jails. Disease-related costs were estimated for adults living with schizophrenia spectrum disorders. Exposures: Health care, supportive housing, homelessness, social security disability benefits, justice system, employment, productivity, quality of life, mortality, and caregiver impact across settings of care. Main Outcomes and Measures: Prevalence-based national and state cost of schizophrenia by category or sector. Results: The societal cost of schizophrenia in 2024 was estimated at $366.8 billion in the US for 3 070 739 adults (1.17%) across all settings (68.4% independent households, 18.6% supportive housing, 5.0% long-term care or skilled nursing facility, 4.7% incarcerated, 3.3% unhoused). Direct costs ($75.0 billion) were attributable to health care ($36.7 billion), supportive housing and homelessness ($35.2 billion), justice system interactions ($11.9 billion), and social security disability benefits ($5.1 billion). Indirect costs ($291.8 billion) resulted from lost wages ($55.4 billion) and reduced quality of life ($41.4 billion) and life expectancy ($47.5 billion). Indirect costs for caregivers of individuals with schizophrenia included unpaid wages for time providing care ($104.6 billion) and impact on caregiver health, productivity, and out-of-pocket costs ($60.5 billion). Per-person costs of schizophrenia were estimated at $119 436 nationally in 2024. State-level per-person costs ranged from $110 975 in Utah to $126 225 in Alaska. Conclusions and Relevance: In 2024, the national and state-level costs of schizophrenia in the US estimated from a societal perspective suggest a substantial burden of disease on individuals, families, and society. These findings provide an important framework to guide prevention, care, and management strategies to reduce costs and improve public health outcomes.