Dembek Carole, Mackie deMauri, Modi Kushal, Zhu Yingying, Niu Xiaoli, Grinnell Todd
Sunovion Pharmaceuticals Inc., Marlborough, MA, USA.
Cerner Enviza, North Kansas City, MO, USA.
Ann Gen Psychiatry. 2023 Mar 24;22(1):13. doi: 10.1186/s12991-023-00440-7.
Bipolar disorder is associated with functional impairment and diminished health-related quality of life (HRQoL). The purpose of this study was to estimate the annual per patient direct healthcare costs, indirect costs, and HRQoL of patients with bipolar disorder by depressive symptom severity and overall compared to the general population in the US.
This cross-sectional study used self-reported data from the 2020 US National Health and Wellness Survey. Adult respondents who reported bipolar disorder symptoms in the past 12 months and/or a diagnosis of bipolar disorder were identified (bipolar disorder cohort) and were further classified by depressive symptom severity based on Patient Health Questionnaire (PHQ-9) scores (none/mild = 0-9, moderate = 10-14, severe = 15-27). Annualized direct healthcare costs and indirect costs were calculated from 6-month healthcare resource utilization and work productivity, respectively. A general population cohort was constructed using 2:1 propensity score matching. Multivariate regression models of all-cause hospitalizations in the past 6 months, annualized direct healthcare costs, annualized indirect costs, and HRQoL (eg, EuroQol 5-Dimension Health Questionnaire (EQ-5D)) controlled for confounders (demographic and clinical characteristics).
Of 3583 adults meeting pre-specified criteria for bipolar disorder, 1401 (39.1%) reported none/mild, 889 (24.8%) moderate, and 1293 (36.1%) severe depressive symptom severity. Additionally, 3285 (91.7%) were matched to 6570 adults in the general population. Compared to the general population, adjusted mean hospitalizations (0.53 vs. 0.30), annualized per patient direct healthcare costs ($20,846 vs. $11,391), and indirect costs ($14,795 vs. $9274) were significantly greater for the bipolar disorder cohort (all p < 0.001); adjusted HRQoL (EQ-5D: 0.69 vs. 0.79) was significantly worse (p < 0.001). By depressive symptom severity, adjusted mean hospitalizations (none/mild = 0.30, moderate = 0.50, severe = 0.46), direct healthcare costs ($14,389, $22,302, $21,341), and indirect costs ($10,799, $17,109, $18,470) were significantly greater for moderate and severe compared to none/mild depressive symptom severity (all p < 0.01); adjusted HRQoL (EQ-5D: 0.77, 0.67, 0.59) was significantly worse (p < 0.001).
Among respondents with bipolar disorder, those with moderate to severe depression had greater direct healthcare costs and indirect costs as well as worse HRQoL than those with mild or no depressive symptoms. Treatment targeting reduction in depressive symptoms may reduce the economic and humanistic burden of bipolar disorder.
双相情感障碍与功能损害及健康相关生活质量（HRQoL）下降有关。本研究的目的是按抑郁症状严重程度评估美国双相情感障碍患者的年度人均直接医疗费用、间接费用和HRQoL，并与普通人群进行总体比较。
这项横断面研究使用了2020年美国国家健康与幸福调查的自我报告数据。确定在过去12个月内报告有双相情感障碍症状和/或被诊断为双相情感障碍的成年受访者（双相情感障碍队列），并根据患者健康问卷（PHQ-9）评分进一步按抑郁症状严重程度分类（无/轻度=0-9分，中度=10-14分，重度=15-27分）。年度直接医疗费用和间接费用分别根据6个月的医疗资源利用情况和工作生产力计算得出。使用2:1倾向评分匹配构建普通人群队列。对过去6个月内全因住院、年度直接医疗费用、年度间接费用和HRQoL（如欧洲五维健康问卷（EQ-5D））的多变量回归模型进行混杂因素（人口统计学和临床特征）控制。
在3583名符合双相情感障碍预先设定标准的成年人中，1401名（39.1%）报告无/轻度抑郁症状，889名（24.8%）为中度，1293名（36.1%）为重度。此外，3285名（91.7%）与普通人群中的6570名成年人进行了匹配。与普通人群相比，双相情感障碍队列的调整后平均住院次数（0.53对0.30）、年度人均直接医疗费用（20846美元对11391美元）和间接费用（14795美元对9274美元）显著更高（所有p<0.001）；调整后的HRQoL（EQ-5D：0.69对0.79）显著更差（p<0.001）。按抑郁症状严重程度划分，中度和重度抑郁症状患者的调整后平均住院次数（无/轻度=0.30，中度=0.50，重度=0.46）、直接医疗费用（14389美元、22302美元、21341美元）和间接费用（10799美元、17109美元、18470美元）显著高于无/轻度抑郁症状患者（所有p<0.01）；调整后的HRQoL（EQ-5D：0.77、0.67、0.59）显著更差（p<0.001）。
在双相情感障碍受访者中，中度至重度抑郁患者的直接医疗费用和间接费用更高，HRQoL也比轻度或无抑郁症状的患者更差。针对减轻抑郁症状的治疗可能会减轻双相情感障碍的经济和人文负担。
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