Brook Richard A, Rajagopalan Krithika, Kleinman Nathan L, Smeeding James E, Brizee Truman J, Gardner Harold H
JeSTARx Group, Newfoundland, N.J., USA.
Prim Care Companion J Clin Psychiatry. 2006;8(1):17-24. doi: 10.4088/pcc.v08n0103.
To compare the costs of employees with bipolar disorder with other employee cohorts and to assess cost differences among employees with bipolar disorder of varying severity.
Retrospective data analysis comparing employees with bipolar disorder (cohort 1) with employees without bipolar disorder (cohort 2), employees with other mental disorders (cohort 3), and employees with no mental disorders (cohort 4). Sick leave, short-term disability, long-term disability, and workers' compensation data were used to compare annual lost time and work-absence costs from January 1, 2001, through December 31, 2002. For bipolar disorder severity and risk stratification, quintiles were identified based on total medical and prescription drug costs and analyzed for many health benefits cost categories.
Cohort 1 was the most costly in nearly every health benefits cost category. All comparisons between cohort 1 and cohorts 2, 3, and 4 yielded significant (p ≤ .05) differences except for sick leave costs in cohorts 1 and 3. The aggregate health benefits costs for the highest-cost cohort 1 quintile were $70,616, or 21 times greater than the health benefits costs for the lowest-cost quintile ($3385). Medical comorbidity costs accounted for most of this difference ($51,495; p ≤ .05).
Employees with bipolar disorder are the most costly in nearly every health benefits category, with a small minority (2.4%) accounting for 20% of the costs. Employers need to identify and target high-risk ("high cost") employees with bipolar disorder and coexisting conditions that use resources more frequently for appropriate interventions that may include early screening and diagnosis, appropriate treatment, and/or behavioral strategies for improved adherence. These strategies have the potential to improve quality of patient care and reduce costs.
比较双相情感障碍员工与其他员工群体的成本，并评估不同严重程度的双相情感障碍员工之间的成本差异。
进行回顾性数据分析，将双相情感障碍员工（队列1）与无精神障碍员工（队列2）、患有其他精神障碍的员工（队列3）以及无精神障碍的员工（队列4）进行比较。利用病假、短期残疾、长期残疾和工伤赔偿数据，比较2001年1月1日至2002年12月31日期间的年度误工时间和缺勤成本。对于双相情感障碍的严重程度和风险分层，根据医疗和处方药总费用确定五分位数，并对多个健康福利成本类别进行分析。
队列1在几乎每个健康福利成本类别中花费最高。队列1与队列2、3和4之间的所有比较均产生显著（p≤0.05）差异，但队列1和队列3的病假成本除外。成本最高的队列1五分位数的总健康福利成本为70,616美元，是成本最低的五分位数（3385美元）的健康福利成本的21倍。医疗合并症成本占了这一差异的大部分（51,495美元；p≤0.05）。
双相情感障碍员工在几乎每个健康福利类别中花费最高，少数（2.4%）员工占成本的20%。雇主需要识别并针对患有双相情感障碍且存在共存疾病的高风险（“高成本”）员工，这些员工更频繁地使用资源，以便进行适当干预，可能包括早期筛查和诊断、适当治疗和/或改善依从性的行为策略。这些策略有可能提高患者护理质量并降低成本。
