Influence of medication choice and comorbid diabetes: the cost of bipolar disorder in a privately insured US population |
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Authors: | Carolyn Harley Hong Li Patricia Corey-Lisle Gilbert J L’Italien William Carson |
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Institution: | (1) i3 Innovus, MN002-0258, 12125 Technology Drive, Eden Prairie, MN 55344, USA;(2) Bristol-Myers Squibb Company, Wallingford, CT, USA;(3) Otsuka America Pharmaceutical Inc., Princeton, NJ, USA |
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Abstract: | Background Bipolar disorder is the most expensive mental disorder for US employer health plans. No published studies have examined the
impact of comorbid diabetes on the cost of treating bipolar disorder. The objectives of this work were to determine the direct
costs incurred by patients with bipolar disorder in a US managed care plan, and to examine the influence (1) of drug therapy
regimen on bipolar-related costs, and (2) of diabetes on bipolar-related and all-cause costs.
Methods A retrospective analysis of claims in a US private insurance database from January 1, 1999 through December 31, 2002 was performed.
The database included at least 4.7 million enrollees each year. Diagnosis codes were used to identify patients with bipolar
disorder; patients with diabetes were identified using diagnosis codes and medication use.
Results From 1999–2002, treated bipolar disorder was identified in 262 (33.9) mean (standard deviation)] cases per 100,000 enrollees.
Among patients with bipolar disorder in this cohort, between 6.3 and 7.4% were treated for diabetes each year. Among patients
with newly treated bipolar disorder, 61.8% received initial therapy with only mood stabilizers, 24.3% received only atypical
antipsychotics, and 13.9% received both. Mean all-cause cost for patients with bipolar disorder was US$2,690 in the 6 months
before the first bipolar-related claim, and US$6,826 in the following year. Of the latter cost, bipolar-related cost was US$1,272.
Patients with comorbid diabetes had much higher all-cause cost (US$11,317) than those without diabetes in the year following
the first bipolar-related claim, but only slightly higher bipolar-related cost (US$1,349). Among newly treated bipolar disorder
patients, all-cause and bipolar-related cost in the year after diagnosis was lowest in patients receiving only mood stabilizers.
Ordinary least squares regression analysis found that treatment with mood stabilizers only was associated with 41% lower bipolar-related
cost than treatment with atypical antipsychotics only (P < .001). Significant individual associations were also found between bipolar-related cost and bipolar disorder I diagnosis,
severe bipolar disorder and comorbid personality disorders (P < .001 for each) but not comorbid diabetes (P = .27).
Conclusions These results suggest that patients with bipolar disorder who receive only mood stabilizer therapy incur lower bipolar-related
and all-cause cost than those receiving only atypical antipsychotics. In contrast to that for all-cause cost, comorbid diabetes
had little impact on direct costs related to treating bipolar disorder itself. |
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Keywords: | atypical antipsychotics bipolar disorder cost diabetes mood stabilizers private payer |
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