ArticleBMJ open2026
Factors associated with high-cost patients with first-episode psychosis: a retrospective study of direct healthcare costs using US private-payer claims data.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- Treatment Adherence and Health Care Utilization After a First Episode of Psychosis.JAMA network open · 2026Article
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundUnderstanding drivers of high healthcare utilisation costs among individuals experiencing first-episode psychosis (FEP) is essential for improving care in those with psychotic disorders.
objectivesTo characterise and compare patient-level factors and longitudinal healthcare utilisation costs across 3 years in FEP high-cost (HC) versus non-high-cost (NHC) patients.
methodsCommercial US insurance claims data from 2013 to 2019 were used to identify HC and NHC patients with FEP. HC were patients accounting for ≥50% of total direct healthcare expenditures within the FEP cohort. Binomial logistic regression was used to identify patient-level factors associated with the HC group. Total healthcare costs and service modalities, including inpatient, outpatient, emergency and prescription drugs, were compared between HC and NHC across time.
resultsOf 27 587 patients with FEP, 12% were HC with higher rates of multiple psychotic disorder diagnoses (p<0.001), chronic medical conditions (p<0.001) and exposure to adverse social determinants of health (p<0.01), particularly for economic category (p<0.001), with vitamin deficiency listed as the highest frequency. Cost analysis revealed a positive relationship between psychosis- and non-psychosis-related conditions, with HC having increased inpatient use for both.
conclusionsFactors associated with being HC in this nationally representative private-payer FEP population were behavioural diagnostic instability, comorbid mental and physical health conditions, and exposure to adverse social factors, including nutritional deficiency. Additionally, psychosis and non-psychosis-related costs stabilise within 2 years. These findings may be important in identifying individuals who may benefit from additional, more intensive services.
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