Birnbaum Howard G, Shi Lizheng, Dial Ellison, Oster Emily F, Greenberg Paul E, Mallett David A
Analysis Group, Inc., 111 Huntington Avenue, Boston, MA 02466, USA.
J Clin Psychiatry. 2003 Oct;64(10):1201-9. doi: 10.4088/jcp.v64n1010.
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.
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.
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 US dollars) in the 12 months following initiation of antidepressant treatment compared with recognized-BP patients ($801 US dollars) and non-BP patients ($585 US dollars). Monthly indirect costs were significantly greater (p <.05) for unrecognized-BP ($570 US dollars) and recognized-BP ($514 US dollars) employees compared with non-BP employees ($335 US dollars) in the 12 months following antidepressant initiation.
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.
这项回顾性研究比较了已确诊和未确诊双相情感障碍患者与无双相情感障碍诊断的抑郁症患者的治疗模式及费用。
利用7家大型全国性雇主涵盖585,584名65岁以下人员的理赔数据，来识别被诊断为抑郁症并最初接受抗抑郁药治疗的患者。使用了1998年至2001年年中的员工以及配偶和受抚养人的数据。根据双相情感障碍诊断理赔标准（ICD - 9编码：296.0、296.1、296.4 - 296.8）和/或情绪稳定剂处方理赔来确定双相情感障碍患者。在被确定为双相情感障碍的患者中，未确诊双相情感障碍（未确诊 - BP）患者在开始使用抗抑郁药后符合标准，而确诊双相情感障碍（确诊 - BP）患者在开始时或之前就符合标准。样本中的其余患者为非双相情感障碍抑郁症（非 - BP）患者。结局指标包括开始抗抑郁药治疗后12个月的治疗模式和每月医疗费用。
在9009名接受抗抑郁药治疗的抑郁症患者中，有8383名非 - BP患者（93.1%）、293名确诊 - BP患者（3.3%）和333名未确诊 - BP患者（3.7%）。联合治疗的使用在非 - BP患者（11%）、未确诊 - BP患者（32%）和确诊 - BP患者（44%）中有所不同（所有两两比较p <.01）。未确诊 - BP患者（14%）使用情绪稳定剂的频率低于确诊 - BP患者（34%）（p <.0001）。与确诊 - BP患者（801美元）和非 - BP患者（585美元）相比，未确诊 - BP患者在开始抗抑郁药治疗后的12个月中每月平均医疗费用显著更高（p <.05）（1179美元）。在开始抗抑郁药治疗后的12个月中，与非 - BP员工（335美元）相比，未确诊 - BP（570美元）和确诊 - BP（514美元）员工的每月间接费用显著更高（p <.05）。
双相情感障碍的药物治疗模式欠佳。准确及时地识别双相情感障碍与较低医疗费用以及因工作损失导致的较低间接费用相关。
