Cost of treating bipolar disorder in the California Medicaid (Meth-Cal) program
Cost of treating bipolar disorder in the California Medicaid (Meth-Cal) program
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DOI：
10.1016/s0165-0327(01)00394-9
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发表时间：
2002-09-01
影响因子：
6.6
通讯作者：
Stimmel, GL
中科院分区：
文献类型：
--
作者：
Li, JM;McCombs, JS;Stimmel, GL
背景：双相情感障碍影响大约1%的人口，在美国每年花费450亿美元。对情绪稳定剂治疗的不依从性估计高达64%。本研究的目的是记录双相情感障碍患者使用情绪稳定剂的模式，并估计与次优药物治疗相关的直接卫生保健费用。方法：使用3349名加州医疗补助双相情感障碍患者的已付索赔记录双相情感障碍患者获得的情绪稳定剂的使用模式。患者的药物使用模式对1年内使用抗精神病药或抗抑郁药的可能性的影响以及治疗后第一年内发生的医疗保健费用也进行了估计。结果：只有42.4%的患者在治疗后的第一年使用了情绪稳定剂；超过60%的接受治疗的患者在1年内改变或增加他们的初始治疗，只有5.5%的患者持续使用情绪稳定剂1年。在第一年延迟或未使用情绪稳定剂的患者中，直接医疗保健费用明显较高。限制：Medi-Cal覆盖穷人和残疾患者，不能代表一般人群。已支付的索赔数据不包括疾病严重程度或治疗反应的临床标记。结论：情绪稳定药物的次优使用模式频繁且昂贵。改善治疗结果需要提高情绪稳定方案依从性的策略，以及新的治疗选择。(C) 2002 Elsevier Science B.V.版权所有
Background: Bipolar disorder affects approximately 1% of the population at an annual cost of $45 billion in the US. Estimates of non-compliance with mood stabilizer therapy range as high as 64%. The objective of this study was to document the use patterns with mood stabilizers achieved by patients with bipolar disorder and to estimate the direct health care costs associated with sub-optimal drug therapy. Methods: Paid claims for 3349 California Medicaid patients with bipolar disorder were used to document the use patterns for mood stabilizers achieved by patients with bipolar disorder. The impact of the patient's drug use patterns on likelihood of antipsychotic or antidepressant use within 1 year and health care costs incurred during the first posttreatment year were also estimated. Results: Only 42.4% of patients used a mood stabilizer during the first posttreatment year; over 60% of treated patients switch or augment their initial therapy within 1 year, and only 5.5% of patients used a mood stabilizer consistently for 1 year. Direct health care costs were significantly higher among those patients who delayed or did not use mood-stabilizing agents during the first year. Limitations: Medi-Cal covers poor and disabled patients and is not representative of the general population. Paid claims data do not include clinical markers for severity of illness or treatment response. Conclusions: Suboptimal use patterns for mood stabilizing medications were frequent and costly. Strategies to improve compliance with mood stabilizer regimens, along with new treatment options, are needed to improve treatment outcomes. (C) 2002 Elsevier Science B.V. All rights reserved.