Guo Jeff J, Keck Paul E, Li Hong, Jang Raymond, Kelton Christina M L
College of Pharmacy, University of Cincinnati Medical Center, Cincinnati, OH, USA.
Value Health. 2008 May-Jun;11(3):416-23. doi: 10.1111/j.1524-4733.2007.00287.x. Epub 2007 Dec 17.
This study measured the treatment cost of bipolar disorder (BPD), decomposed the cost into that portion which was directly BPD-related and that attributable to comorbidities, and compared health-care utilization and costs across groups of patients with different drug regimens.
Using a multistate managed-care-organization claims database, a cohort of 67,862 BPD patients were selected and followed for the length of their enrollment between January 1, 1998 and December 31, 2002. All costs associated with the patients' medical claims were adjusted to 2002 dollars using the medical component of Consumer Price Index. Patients were classified into three groups based on their drug regimen: atypical antipsychotics (ATYP), atypical antipsychotics plus mood stabilizers (ATYP + MS), and mood stabilizers only (MS). The Charlson comorbidity index was used to control for comorbid conditions. Using both Poisson and log-linear regression analyses, numbers of hospitalizations, emergency room (ER) visits, and outpatient visits, as well as treatment costs per enrolled month, were regressed on age, sex, medication regimen, and clinical comorbidities.
The mean charge and reimbursement per patient-year were $12,797 and $6581, respectively. Of the treatment cost, 33% was BPD-related, and 67% was attributed to comorbidities. Compared to patients in the MS treatment regimen, higher treatment costs were associated with ATYP (Rate Ratio = 1.24, 95% CI 1.17-1.31) and ATYP + MS (RR = 1.52, 1.47-1.56). Moreover, higher costs were associated with key comorbidities like personality disorder (RR = 1.45, 1.37-1.53). Patients on the ATYP regimen had higher risks of hospitalization (RR = 1.44, 1.33-1.56) and ER visits (RR = 1.15, 1.04-1.27), but lower risk of outpatient visits (RR = 0.81, 0.76-0.86).
Controlling treatment costs for BPD patients requires focusing on patients with key comorbidities and monitoring the association between treatment regimen and resource use.
本研究测量了双相情感障碍（BPD）的治疗成本，将成本分解为直接与BPD相关的部分和归因于合并症的部分，并比较了不同药物治疗方案患者组之间的医疗保健利用情况和成本。
利用一个多状态管理式医疗组织的索赔数据库，选取了67862名BPD患者组成队列，并在1998年1月1日至2002年12月31日他们的参保期间进行跟踪。与患者医疗索赔相关的所有成本均使用消费者价格指数的医疗部分调整为2002年美元。根据患者的药物治疗方案将其分为三组：非典型抗精神病药物（ATYP）组、非典型抗精神病药物加心境稳定剂（ATYP + MS）组和仅使用心境稳定剂（MS）组。使用查尔森合并症指数来控制合并症情况。通过泊松回归和对数线性回归分析，将住院次数、急诊室（ER）就诊次数、门诊就诊次数以及每月参保治疗成本，对年龄、性别、药物治疗方案和临床合并症进行回归分析。
每位患者每年的平均费用和报销分别为12797美元和6581美元。在治疗成本中，33%与BPD相关，67%归因于合并症。与MS治疗方案的患者相比，ATYP组（率比 = 1.24，95%可信区间1.17 - 1.31）和ATYP + MS组（RR = 1.52，1.47 - 1.56）的治疗成本更高。此外，与人格障碍等关键合并症相关的成本更高（RR = 1.45，1.37 - 1.53）。ATYP治疗方案的患者住院风险更高（RR = 1.44，1.33 - 1.56）和急诊室就诊风险更高（RR = 1.15，1.04 - 1.27），但门诊就诊风险更低（RR = 0.81，0.76 - 0.86）。
控制BPD患者的治疗成本需要关注有关键合并症的患者，并监测治疗方案与资源使用之间的关联。
