Dardennes R, Thuile J, Friedman S, Guelfi J D
Université Paris Descartes, Faculté de Médecine Cochin-Port-Royal et CH Sainte-Anne, Paris.
Encephale. 2006 Jan-Feb;32(1 Pt 1):18-25. doi: 10.1016/s0013-7006(06)76133-4.
According to the estimates of the World Bank and the World Health Organization bipolar disorder is the sixth leading cause of handicap throughout the world. The burden of this disease is similar to the one of schizophrenia. But cost-of-illness studies are too seldom. Although preventive treatments of bipolar disorder are available for more than fifty years, their economic impact has rarely been studied.
This review shows that the yearly cost of bipolar disorder is between 10,000 and 16,000 euro (12,000 and 18,000 US dollars). Eighty percent are indirect costs, 15% are linked to hospitalization and 5% to drugs. Hospitalization costs are lower in Health Maintenance Organization or general population studies than in studies performed on populations receiving care from psychiatric institutions or with a low socio-economic status.
The use of mood stabilizers has a substantial impact on direct costs which are halved and consequently on indirect costs. But different surveys all agree on the dramatic under-use of mood stabilizers which may be adequately prescribed to only a quarter of bipolar patients.
Therefore, the optimization of mental health system resources should prompt incentives to better screen, diagnose, and treat patients with a bipolar disorder.
根据世界银行和世界卫生组织的估计，双相情感障碍是全球致残的第六大主要原因。这种疾病的负担与精神分裂症相当。但疾病成本研究很少。尽管双相情感障碍的预防性治疗已有五十多年历史，但其经济影响很少被研究。
本综述表明，双相情感障碍的年成本在10,000至16,000欧元（12,000至18,000美元）之间。80%是间接成本，15%与住院相关，5%与药物相关。健康维护组织或普通人群研究中的住院成本低于对接受精神病机构护理或社会经济地位较低人群进行的研究。
使用心境稳定剂对直接成本有重大影响，直接成本减半，进而对间接成本也有影响。但不同调查都一致认为心境稳定剂的使用严重不足，只有四分之一的双相情感障碍患者可能得到适当处方。
因此，优化精神卫生系统资源应促使采取激励措施，以更好地筛查、诊断和治疗双相情感障碍患者。
