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The social and economic burden of treatment-resistant schizophrenia: a systematic literature review

Kennedy, James L.a; Altar, C. Anthonyb; Taylor, Danielle L.a; Degtiar, Irinac; Hornberger, John C.c,d

International Clinical Psychopharmacology: March 2014 - Volume 29 - Issue 2 - p 63–76
doi: 10.1097/YIC.0b013e32836508e6

Patients with schizophrenia often fail to respond to an initial course of therapy. This study systematically reviewed the societal and economic burden of treatment-resistant schizophrenia (TRS). Studies that described patients with TRS published 1996–2012 were included if they collected primary data on clinical, social, or economic outcomes. All studies were independently reviewed and extracted by at least two investigators. Sixty-five studies were identified. Almost 60% (SD 18%) of patients failed to achieve response after 23 weeks on antipsychotic drug therapy. Patients with TRS had high rates of smoking (56%), alcohol abuse (51%), substance abuse (51%), and suicide ideation (44%). The incidence of severe adverse events to treatment was 4% (SD 7%). Mean quality of life for patients who were unresponsive or intolerant to treatment was ∼20% lower than that of patients in remission. Annual costs for patients with schizophrenia are $15 500–$22 300 and are 3–11-fold higher for patients with TRS. TRS remains common and costly, despite availability of many treatment options, and contributes to a significant loss in patient quality of life. Although estimates in the literature vary greatly, TRS conservatively adds more than $34 billion in annual direct medical costs in the USA.

aDepartment of Psychiatry, University of Toronto, Toronto, Ontario, Canada

bAssureRx Health Inc., Mason, Ohio

cCedar Associates LLC, Menlo Park

dDepartment of Internal Medicine, Stanford University School of Medicine, Stanford, California, USA

Correspondence to John C. Hornberger, MD, MS, Cedar Associates LLC, 3715 Haven Ave., Suite 100, Menlo Park, CA 94025, USA Tel: +1 650 257 3315; fax: +1 650 257 3328;

Received December 24, 2012

Accepted July 4, 2013

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