Factors associated with high-cost patients with first-episode psychosis: a retrospective study of direct healthcare costs using US private-payer claims data.

BACKGROUND

Understanding drivers of high healthcare utilisation costs among individuals experiencing first-episode psychosis (FEP) is essential for improving care in those with psychotic disorders.

OBJECTIVES

To 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.

METHODS

Commercial 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.

RESULTS

Of 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.

CONCLUSIONS

Factors 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.