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Early Interv Psychiatry. 2018 Oct 12. doi: 10.1111/eip.12752. [Epub ahead of print]

Understanding the direct and indirect costs of a first episode of psychosis program: Insights from PAFIP of Cantabria, Spain, during the first year of intervention.

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Department of Psychiatry, Sierrallana Hospital, Torrelavega, Cantabria, Spain.
School of Medicine, University of Cantabria, Santander, Spain.
Instituto de Investigación Sanitaria Valdecilla. IDIVAL, Santander, Spain.
Centro de Investigación Biomédica en Red en Salud Mental CIBERSAM, Spain.
Faculty of Economics, University of Cantabria, GIECONPSALUD, Santander, Spain.
Nursing School, University of Cantabria, IDIVAL, GI Derecho Sanitario y Bioética. GRIDES. Cantabria, Spain.
Department Psychiatry, University Hospital La Princesa, Autonomous University of Madrid, Madrid, Spain.
Department of Psychiatry, University Hospital Marqués Valdecilla, Santander, Spain.



Early intervention psychiatric services for patients with psychosis aim to limit the most damaging outcomes and reduce the patient's risk of social drift, decreasing illness severity and thus containing healthcare costs. There is a scarcity of studies that focus on first-episode psychosis (FEP), and those few that have been published only looked at direct health costs, but not at indirect costs, which make up the bulk of the budget. Our study aims to explore the short-term (1-year follow-up) economic cost of a FEP Program, including both direct and indirect costs.


Data were collected retrospectively from the clinical records of 157 patients included in the Programa Atención Fases Iniciales de Psicosis, from Marqués de Valdecilla University Hospital, Santander. Our data collection sheet collated data from direct and indirect costs associated with the illness. Data were also extracted from the Cantabria Health Service Records. STATA 15.0 was used for statistical analysis.


On average, the total costs during the first year were €48 353.51 per patient, with direct healthcare costs being €13 729.47 (28.39%), direct non-medical costs €108.6 (0.22%), and indirect costs €34 515.44 (71.39%). We found that hospitalization costs were higher in males (p = 0.081) and in cannabis users (p = 0.032). The number of relapses increased both, hospitalization and treatment costs (r = 0.40 p = 0.000; r = 0.24 p = 0.067, respectively).


Intensive Early Intervention in Psychosis Services may result in cost savings by decreasing hospitalization, premature mortality, disability, unemployment, and legal problems; however, the first year after diagnosis would represent the one with the highest costs.


costs analysis; early intervention services; first episode psychosis; schizophrenia


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