Economic Consequences of Not Recognizing Bipolar Disorder Patients: A Cross-Sectional Descriptive Analysis
J Clin Psychiatry 2003;64(10):1201-1209
© Copyright 2014 Physicians Postgraduate Press, Inc.
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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
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.