Economic consequences of not recognizing bipolar disorder patients: A cross-sectional descriptive analysis
Economic consequences of not recognizing bipolar disorder patients: A cross-sectional descriptive analysis
复制标题
DOI：
10.4088/jcp.v64n1010
复制
发表时间：
2003-10-01
影响因子：
5.3
通讯作者：
Mallett, DA
中科院分区：
文献类型：
--
作者：
Birnbaum, HG;Shi, LZ;Mallett, DA
背景资料：这项回顾性研究比较了治疗模式和费用的患者与公认的和未被承认的双相情感障碍与抑郁症患者没有双相情感障碍claims.Method：索赔数据7个大型国家的雇主，涵盖585,584人年龄小于65岁，用于确定患者诊断为抑郁症，并初步治疗与抗抑郁药。使用了1998年至2001年年中雇员以及配偶和受抚养人的数据。根据双相情感障碍诊断声明（ICD-9代码：296.0、296.1、296.4-296.8）和/或情绪稳定剂处方声明的标准，将患者确定为双相情感障碍。在确定为双相情感障碍的患者中，未识别的双相情感障碍（未识别的BP）患者在抗抑郁药治疗开始后符合标准，而识别的双相情感障碍（识别的BP）患者在治疗开始时或之前符合标准。样本中的其余患者为非双相抑郁（非BP）患者。结果的措施，包括治疗模式和每月的医疗费用在12个月后开始的抗抑郁剂treatment.Results：9009例抑郁症与抗抑郁药治疗，有8383非BP患者（93.1%），293承认BP患者（3.3%），和333不承认BP患者（3.7%）。非BP（11%）、未识别BP（32%）和识别BP患者（44%）使用联合治疗的情况各不相同（均为成对p <0.01）。情绪稳定剂的使用在未识别BP患者中（14%）比识别BP患者（34%）更少（p <0.0001）。在开始抗抑郁治疗后的12个月内，未识别的BP患者的平均每月医疗费用（1179美元）显著高于（p <0.05）识别的BP患者（801美元）和非BP患者（585美元）。每月间接成本显着更大（p <0.05）为未识别的BP（570美元）和公认的BP（514美元）的员工相比，非BP员工（335美元），在12个月后开始使用抗抑郁药。结论：双相情感障碍的药物治疗模式是次优的。双相情感障碍的准确和及时识别与较低的医疗费用和较低的间接费用，由于工作损失。
Background: This retrospective study compared treatment patterns and costs for patients with recognized and unrecognized bipolar disorder with those of depressed patients without a bipolar disorder claim.Method: Claims data for 7 large national employers covering 585,584 persons aged less than 65 years were used to identify patients diagnosed with depression and initially treated with antidepressants. Data on employees, as well as spouses and dependents, for the period 1998 to mid-2001 were used. Patients were identified as bipolar based on the criteria of a bipolar diagnosis claim (ICD-9 codes: 296.0, 296.1, 296.4-296.8) and/or a mood stabilizer prescription claim. Of the patients identified as bipolar, unrecognized bipolar disorder (unrecognized-BP) patients met the criteria after antidepressant initiation, while recognized bipolar disorder (recognized-BP) patients met the criteria at or before initiation. The remaining patients in the sample were non-bipolar depressed (non-BP) patients. Outcome measures included treatment patterns and monthly medical costs in the 12 months subsequent to initiation of antidepressant treatment.Results: Of the 9009 patients treated for depression with antidepressants, there were 8383 non-BP patients (93.1%), 293 recognized-BP patients (3.3%), and 333 unrecognized-BP patients (3.7%). Use of combination therapies varied among the non-BP (11%), unrecognized-BP (32%), and recognized-BP patients (44%) (all pairwise p < .01). Use of mood stabilizers was less frequent among unrecognized-BP patients (14%) than recognized-BP patients (34%) (p < .0001). Unrecognized-BP patients incurred significantly greater (p < .05) mean monthly medical costs ($1179) in the 12 months following initiation of antidepressant treatment compared with recognized-BP patients ($801) and non-BP patients ($585). Monthly indirect costs were significantly greater (p < .05) for unrecognized-BP ($570) and recognized-BP ($514) employees compared with non-BP employees ($335) in the 12 months following antidepressant initiation.Conclusions: Patterns of medication treatment for bipolar disorder were suboptimal. Accurate and timely recognition of bipolar disease was associated with lower medical costs and lower indirect costs due to work loss.