Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
AbbVie, Irvine, CA, USA.
J Med Econ. 2022 Jan-Dec;25(1):1110-1117. doi: 10.1080/13696998.2022.2120264.
To our knowledge, literature describing the place of care and associated costs during acute bipolar I disorder (BP-I) episodes is limited. We conducted a claims-based retrospective study to address this gap.
Adults with BP-I were identified via IBM MarketScan Commercial and Medicare Supplemental databases. The acute episode index date was defined by ≥1 inpatient BP-I claim(s) or ≥1 outpatient or ≥3 outpatient BP-I claims (depending on visit type) in a 2-week (manic/mixed) or 4-week (depressive) period. Likely acute episodes were defined as 3- and 6-week periods for manic/mixed and depressive episodes, respectively; total mental health-related medical costs (health plan + patient) were collected during these intervals and stratified by setting (inpatient versus outpatient). Initial and subsequent episodes were captured; data were reported in subgroups without and with clozapine use, a proxy for disease severity. The remission index date was the earliest outpatient claim with a bipolar remission diagnosis with no acute episode or treatment. Remission costs were collected over a 3-month period. All results were analyzed descriptively.
A total of 41,516 patients with 130,221 acute manic/mixed episodes and 47,763 patients with 149,207 acute depressive episodes met the study criteria. Over 84% of acute episodes were treated in outpatient settings. Mental health-related medical costs for manic/mixed episodes were $15,444 for inpatient and $1,577 for outpatient settings; inpatient and outpatient costs for depressive episodes were $17,376 and $2,154, respectively. Health plans covered approximately 78% of medical costs for both episode types with and without prior clozapine use. A total of 8,143 patients met remission criteria; the total 3-month outpatient costs were $1,225.
Most BP-I acute manic/mixed or depressive episodes were treated in the outpatient setting. Episodes with inpatient care were 8-10 times more costly than outpatient-only episodes. Health plans covered most medical costs, but additional patient-incurred out-of-pocket costs remained.
据我们所知，描述急性双相情感障碍（BP-I）发作期间的治疗地点和相关费用的文献有限。我们进行了一项基于索赔的回顾性研究来填补这一空白。
通过 IBM MarketScan 商业和医疗保险补充数据库确定患有 BP-I 的成年人。急性发作索引日期通过以下方式定义：在 2 周（躁狂/混合）或 4 周（抑郁）期间，≥1 次住院 BP-I 索赔或≥1 次门诊或≥3 次门诊 BP-I 索赔（取决于就诊类型）；躁狂/混合发作的可能急性发作期定义为 3 周和 6 周；抑郁发作分别为 6 周和 12 周；在此期间收集了所有心理健康相关的医疗费用（健康计划+患者），并按治疗地点（住院与门诊）进行分层。捕获了首发和后续发作；数据报告了无和有氯氮平使用的亚组，氯氮平是疾病严重程度的替代指标。缓解索引日期是最早的门诊索赔，有双相缓解诊断，没有急性发作或治疗。缓解费用在 3 个月期间收集。所有结果均进行描述性分析。
共有 41516 名患者有 130221 次急性躁狂/混合发作，47763 名患者有 149207 次急性抑郁发作符合研究标准。超过 84%的急性发作在门诊治疗。躁狂/混合发作的心理健康相关医疗费用分别为住院 15444 美元和门诊 1577 美元；抑郁发作的住院和门诊费用分别为 17376 美元和 2154 美元。有和没有氯氮平使用史的两种发作类型，健康计划均覆盖了约 78%的医疗费用。共有 8143 名患者符合缓解标准；总 3 个月的门诊费用为 1225 美元。
大多数 BP-I 急性躁狂/混合或抑郁发作在门诊治疗。住院治疗的发作比仅门诊治疗的发作费用高 8-10 倍。健康计划覆盖了大部分医疗费用，但患者仍需承担额外的自付费用。
