Menzin Joseph, Sussman Matthew, Tafesse Eskinder, Duczakowski Christina, Neumann Peter, Friedman Mark
Boston Health Economics, Inc., 20 Fox Rd., Waltham, MA 02451, USA.
J Clin Psychiatry. 2009 Sep;70(9):1230-6. doi: 10.4088/JCP.08m04939. Epub 2009 Aug 11.
Unrecognized bipolar disorder in patients presenting with a major depressive episode may lead to delayed diagnosis, inappropriate treatment, and excessive costs. This study models the cost effectiveness of screening for bipolar disorder among adults presenting for the first time with symptoms of major depressive disorder.
A decision-analysis model was used to evaluate the outcomes and cost over 5 years of screening versus not screening for bipolar disorder. Screening was defined as a 1-time administration of the Mood Disorder Questionnaire at the initial visit followed by referral to a psychiatrist for patients screening positive for bipolar disorder. Health states included correctly diagnosed bipolar disorder, unrecognized bipolar disorder, and correctly diagnosed major depressive episodes. Model outcomes included rates of correct diagnosis of bipolar disorder and discounted costs (2006 US dollars) of screening and treating major depressive episodes. Literature was the primary source of data and was collected from September 2007 through March 2009.
According to the model, 1,000 adults in a health plan with 1 million adult members annually present with symptoms of major depressive disorder. An additional 38 patients were correctly diagnosed with depression (unipolar or a major depressive episode) or bipolar disorder (440 with screening vs 402 without screening) through a 1-time screening for bipolar disorder. Estimated 5-year discounted costs per patient were $36,044 without screening and $34,107 with screening (savings of $1,937). Accordingly, total 5-year budgetary savings were estimated at $1.94 million. Results were most sensitive to difference in treatment costs for patients with recognized versus unrecognized bipolar disorder.
A 1-time screening program for bipolar disorder, when patients first present with a major depressive episode, can reduce health care costs to managed-care plans.
首次出现重度抑郁发作的患者中未被识别的双相情感障碍可能导致诊断延迟、治疗不当及费用过高。本研究建立模型，评估首次出现重度抑郁障碍症状的成年人中筛查双相情感障碍的成本效益。
采用决策分析模型评估筛查与不筛查双相情感障碍5年期间的结局和成本。筛查定义为初次就诊时一次性使用心境障碍问卷，对筛查双相情感障碍呈阳性的患者转诊至精神科医生处。健康状态包括双相情感障碍被正确诊断、未被识别的双相情感障碍以及重度抑郁发作被正确诊断。模型结局包括双相情感障碍的正确诊断率以及筛查和治疗重度抑郁发作的贴现成本（2006年美元）。文献是数据的主要来源，于2007年9月至2009年3月收集。
根据模型，在一个每年有100万成年成员的健康计划中，每年有1000名成年人出现重度抑郁障碍症状。通过一次性筛查双相情感障碍，另外有38名患者被正确诊断为抑郁症（单相或重度抑郁发作）或双相情感障碍（筛查组440例，未筛查组402例）。未筛查时每位患者5年的估计贴现成本为36,044美元，筛查时为34,107美元（节省1,937美元）。因此，5年的总预算节省估计为194万美元。结果对已识别与未识别双相情感障碍患者的治疗成本差异最为敏感。
当患者首次出现重度抑郁发作时，对双相情感障碍进行一次性筛查计划可降低管理式医疗计划的医疗成本。
