Thomson Reuters, Washington, DC, USA.
J Med Econ. 2010;13(4):698-704. doi: 10.3111/13696998.2010.531828. Epub 2010 Nov 15.
To compare characteristics, healthcare resource utilization and costs of Medicaid bipolar disorder (BPD) type I (BP-I) patients with and without frequent psychiatric intervention (FPI).
Adults with BP-I, ≥ 1 prescription claim for a mood stabilizer/atypical antipsychotic and 24 months' continuous medical/prescription coverage were identified (MarketScan* Medicaid database). Patients with ≥ 2 clinically significant events (CSEs) during a 12-month identification period had FPI. CSEs included emergency department (ED) visits or hospitalizations with a principal diagnosis of BPD, addition of a new medication to the first observed treatment regimen or ≥ 50% increase in BPD medication dose. Demographic and clinical characteristics were evaluated for the identification period, and healthcare utilization and costs for the 12-month follow-up. Multivariate generalized linear modeling and multivariate logistic regression, respectively, were used to evaluate the impact of FPI on all-cause and psychiatric-related costs and risk of psychiatric-related hospitalization and ED visit during follow-up.
Of 5,527 BP-I patients, 53% had FPI. Relative to patients without FPI, those with FPI were younger and more likely to be female, had higher adjusted all-cause (+US$3,232, p < 0.001) and psychiatric-related (+US$2,519, p < 0.001) costs and higher risk of hospitalization (adjusted odds ratio [OR] = 3.681, 95% confidence interval [CI] = 2.85-4.75) and ED visit (OR = 3.094, 95% CI = 2.55-3.76).
Analysis used a convenience sample of Medicaid enrollees in several geographically dispersed states, limiting generalizability. Analyses of administrative claims data depend on accurate diagnoses and data entry.
BP-I patients with FPI incurred significantly higher healthcare resource utilization and costs during the follow-up period than those without FPI.
比较 Medicaid 双相障碍 I 型（BP-I）患者中伴有和不伴有频繁精神科干预（FPI）的特征、医疗资源利用情况和成本。
在 MarketScan* Medicaid 数据库中，确定了符合以下条件的 BP-I 成年患者：至少有 1 份心境稳定剂/非典型抗精神病药物的处方和 24 个月的连续医疗/处方覆盖范围。在 12 个月的识别期内，患者出现≥2 次临床显著事件（CSEs），则判定为有 FPI。CSEs 包括因 BPD 导致的急诊就诊或住院，首次观察治疗方案中添加新药物或 BPD 药物剂量增加≥50%。在识别期评估人口统计学和临床特征，并在 12 个月的随访期间评估医疗保健利用情况和成本。分别使用多元广义线性模型和多元逻辑回归评估 FPI 对所有原因和精神科相关成本的影响，以及对随访期间精神科相关住院和 ED 就诊的风险。
在 5527 名 BP-I 患者中，有 53%有 FPI。与无 FPI 的患者相比，有 FPI 的患者年龄更小，女性比例更高，调整后的全因（+3232 美元，p < 0.001）和精神科相关（+2519 美元，p < 0.001）费用更高，住院（调整后的优势比 [OR] = 3.681，95%置信区间 [CI] = 2.85-4.75）和 ED 就诊（OR = 3.094，95% CI = 2.55-3.76）的风险更高。
分析使用了来自几个地理位置分散的州的 Medicaid 参保者的便利样本，限制了其普遍性。对行政索赔数据的分析取决于准确的诊断和数据输入。
在随访期间，伴有 FPI 的 BP-I 患者的医疗资源利用和成本明显高于不伴有 FPI 的患者。
