The relative efficiency of schizophrenia health care systems: an international comparison using data envelopment analysis

James Weatherall, Jacob Simonsen, Brian L. Odlaug

Research output: Contribution to journalArticlepeer-review


Aim: To compare the health economic efficiency of health care systems across nations, within the area of schizophrenia, using a data envelopment analysis (DEA) approach. Methods: The DEA was performed using countries as decision-making units, schizophrenia disease investment (cost of disease as a percentage of total health care expenditure) as the input, and disability-adjusted life years (DALYs) per patient due to schizophrenia as the output. Data were obtained from the Global Burden of Disease 2017 study, the World Bank Group, and a literature search of the PubMed database. Results: Data were obtained for 44 countries; of these, 34 had complete data and were included in the DEA. Disease investment (percentage of total health care expenditure) ranged from 1.11 in Switzerland to 6.73 in Thailand. DALYs per patient ranged from 0.621 in Lithuania to 0.651 in Malaysia. According to the DEA, countries with the most efficient schizophrenia health care were Lithuania, Norway, Switzerland and the US (all with efficiency score 1.000). The least efficient countries were Malaysia (0.955), China (0.959) and Thailand (0.965). Limitations: DEA findings depend on the countries and variables that are included in the dataset. Conclusions: In this international DEA, despite the difference in schizophrenia disease investment across countries, there was little difference in output as measured by DALYs per patient. Potentially, Lithuania, Norway, Switzerland and the US should be considered ‘benchmark’ countries by policy makers, thereby providing useful information to countries with less efficient systems.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalJournal of Medical Economics
StatePublished - 2020
Externally publishedYes

Bibliographical note

Funding Information:
JW, JS and BLO are full-time employees of H. Lundbeck A/S. Prior to employment with H. Lundbeck A/S, BLO was a paid consultant for H. Lundbeck A/S. He has received research grants from The TLC Foundation for Body-Focused Repetitive Behaviors and National Center for Responsible Gaming. BLO receives royalties from Oxford University Press and Johns Hopkins University Press.

Funding Information:
Alice Field, BSc, of Cambridge Medical Communication Ltd (Cambridge, UK) assisted with data collection. Writing support was provided by Chris Watling, PhD, assisted by his colleagues at Cambridge Medical Communication Ltd, and funded by H. Lundbeck A/S.

Publisher Copyright:
© 2020, © 2020 H. Lundbeck A/S. Published by Informa UK Limited, trading as Taylor & Francis Group.

Copyright 2020 Elsevier B.V., All rights reserved.


  • Benchmarking
  • budget impact
  • clinical effectiveness
  • cost effectiveness
  • DEA
  • health economics and outcomes research

PubMed: MeSH publication types

  • Journal Article


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