Hidalgo-Mazzei Diego, Undurraga Juan, Reinares María, Bonnín Caterina del Mar, Sáez Cristina, Mur María, Nieto Evaristo, Vieta Eduard
Programa de Trastornos Bipolares, Instituto de Neurociencias, Hospital Clínic de Barcelona, IDIBAPS, CIBERSAM, Universidad de Barcelona, Barcelona, Cataluña, España.
Programa de Trastornos Bipolares, Instituto de Neurociencias, Hospital Clínic de Barcelona, IDIBAPS, CIBERSAM, Universidad de Barcelona, Barcelona, Cataluña, España; Departamento de Psiquiatría, Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile.
Rev Psiquiatr Salud Ment. 2015 Apr-Jun;8(2):55-64. doi: 10.1016/j.rpsm.2015.01.003. Epub 2015 Mar 6.
Bipolar disorder is a relapsing-remitting condition affecting approximately 1-2% of the population. Even when the treatments available are effective, relapses are still very frequent. Therefore, the burden and cost associated to every new episode of the disorder have relevant implications in public health. The main objective of this study was to estimate the associated health resource consumption and direct costs of manic episodes in a real world clinical setting, taking into consideration clinical variables.
Bipolar I disorder patients who recently presented an acute manic episode based on DSM-IV criteria were consecutively included. Sociodemographic variables were retrospectively collected and during the 6 following months clinical variables were prospectively assessed (YMRS,HDRS-17,FAST and CGI-BP-M). The health resource consumption and associate cost were estimated based on hospitalization days, pharmacological treatment, emergency department and outpatient consultations.
One hundred sixty-nine patients patients from 4 different university hospitals in Catalonia (Spain) were included. The mean direct cost of the manic episodes was €4,771. The 77% (€3,651) was attributable to hospitalization costs while 14% (€684) was related to pharmacological treatment, 8% (€386) to outpatient visits and only 1% (€50) to emergency room visits. The hospitalization days were the main cost driver. An initial FAST score>41 significantly predicted a higher direct cost.
Our results show the high cost and burden associated with BD and the need to design more cost-efficient strategies in the prevention and management of manic relapses in order to avoid hospital admissions. Poor baseline functioning predicted high costs, indicating the importance of functional assessment in bipolar disorder.
双相情感障碍是一种复发缓解性疾病，影响着约1% - 2%的人口。即使现有的治疗方法有效，复发仍然非常频繁。因此，该疾病每次新发作所带来的负担和成本对公共卫生具有重要影响。本研究的主要目的是在真实临床环境中，考虑临床变量，估算躁狂发作相关的卫生资源消耗和直接成本。
连续纳入近期根据《精神疾病诊断与统计手册》第四版（DSM-IV）标准出现急性躁狂发作的双相I型障碍患者。回顾性收集社会人口统计学变量，并在接下来的6个月内前瞻性评估临床变量（杨氏躁狂量表、17项汉密尔顿抑郁量表、功能评估短表和双相障碍临床总体印象量表-躁狂）。根据住院天数、药物治疗、急诊科就诊和门诊会诊估算卫生资源消耗及相关成本。
纳入了来自西班牙加泰罗尼亚4家不同大学医院的169名患者。躁狂发作的平均直接成本为4771欧元。其中77%（3651欧元）归因于住院成本，14%（684欧元）与药物治疗相关，8%（386欧元）与门诊就诊相关，而仅有1%（50欧元）与急诊室就诊相关。住院天数是主要的成本驱动因素。初始功能评估短表得分>41显著预测了更高的直接成本。
我们的结果表明双相情感障碍相关的高成本和负担，以及需要设计更具成本效益的策略来预防和管理躁狂复发以避免住院。基线功能差预示着高成本，表明双相情感障碍功能评估的重要性。
