Cost of treating bipolar disorder in the California Medicaid (Medi-Cal) program

Department of Pharmaceutical Economics and Policy, University of Southern California School of Pharmacy, 1540 E. Alcazar St., Rm. CHP-140, Los Angeles, CA 90033, USA.
Journal of Affective Disorders (Impact Factor: 3.38). 10/2002; 71(1-3):131-9. DOI: 10.1016/S0165-0327(01)00394-9
Source: PubMed


Bipolar disorder affects approximately 1% of the population at an annual cost of $45 billion in the US. Estimates of non-compliance with mood stabilizer therapy range as high as 64%. The objective of this study was to document the use patterns with mood stabilizers achieved by patients with bipolar disorder and to estimate the direct health care costs associated with sub-optimal drug therapy.
Paid claims for 3,349 California Medicaid patients with bipolar disorder were used to document the use patterns for mood stabilizers achieved by patients with bipolar disorder. The impact of the patient's drug use patterns on likelihood of antipsychotic or antidepressant use within 1 year and health care costs incurred during the first posttreatment year were also estimated.
Only 42.4% of patients used a mood stabilizer during the first posttreatment year; over 60% of treated patients switch or augment their initial therapy within 1 year, and only 5.5% of patients used a mood stabilizer consistently for 1 year. Direct health care costs were significantly higher among those patients who delayed or did not use mood-stabilizing agents during the first year.
Medi-Cal covers poor and disabled patients and is not representative of the general population. Paid claims data do not include clinical markers for severity of illness or treatment response.
Suboptimal use patterns for mood stabilizing medications were frequent and costly. Strategies to improve compliance with mood stabilizer regimens, along with new treatment options, are needed to improve treatment outcomes.

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    • "Medication treatment patterns are variable in the acute and long-term management of bipolar disorder, with 42-64% of patients receiving mood stabilizers, such as lithium, valproate or carbamazapine, and 44-60% receiving adjunctive antipsychotics [4-6]. Atypical antipsychotics are used alone or in combination with mood stabilizers for more severe manic episodes [7-11]. "
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    ABSTRACT: This study compared 1-year risk of psychiatric hospitalization and treatment costs in commercially insured patients with bipolar disorder, treated with aripiprazole, ziprasidone, olanzapine, quetiapine or risperidone. This was a retrospective propensity score-matched cohort study using the Ingenix Lab/Rx integrated insurance claims dataset. Patients with bipolar disorder and 180 days of pre-index enrollment without antipsychotic exposure who received atypical antipsychotic agents were followed for up to 12 months following the initial antipsychotic prescription. The primary analysis used Cox proportional hazards regression to evaluate time-dependent risk of hospitalization, adjusting for age, sex and pre-index hospitalization. Generalized gamma regression compared post-index costs between treatment groups. Compared to aripiprazole, ziprasidone, olanzapine and quetiapine had higher risks for hospitalization (hazard ratio 1.96, 1.55 and 1.56, respectively; p < 0.05); risperidone had a numerically higher but not statistically different risk (hazard ratio 1.37; p = 0.10). Mental health treatment costs were significantly lower for aripiprazole compared with ziprasidone (p = 0.004) and quetiapine (p = 0.007), but not compared to olanzapine (p = 0.29) or risperidone (p = 0.80). Total healthcare costs were significantly lower for aripiprazole compared to quetiapine (p = 0.040) but not other comparators. In commercially insured adults with bipolar disorder followed for 1 year after initiation of atypical antipsychotics, treatment with aripiprazole was associated with a lower risk of psychiatric hospitalization than ziprasidone, quetiapine, olanzapine and risperidone, although this did not reach significance with the latter. Aripiprazole was also associated with significantly lower total healthcare costs than quetiapine, but not the other comparators.
    Full-text · Article · Jan 2011 · BMC Psychiatry
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    • "On the other hand, use of antidepressants, mainly tricyclics or MAO inhibitors [2] and very likely dual antidepressants [3,4] has been related with manic switch, rapid cycling or worse outcome in bipolar patients. Thus, a more accurate diagnosis of those apparently "pseudounipolar" patients might lead to a more adequate treatment and subsequently contribute to reduce the personal and financial burdens related to an incorrect diagnosis [5]. "
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    ABSTRACT: According to some studies, almost 40% of depressive patients - half of them previously undetected - are diagnosed of bipolar II disorder when systematically assessed for hypomania. Thus, instruments for bipolar disorder screening are needed. The Mood Disorder Questionnaire (MDQ) is a self-reported questionnaire validated in Spanish in stable patients with a previously known diagnosis. The purpose of this study is to evaluate in the daily clinical practice the usefulness of the Spanish version of the MDQ in depressive patients. Patients (n = 87) meeting DSM-IV-TR criteria for a major depressive episode, not previously known as bipolar were included. The affective module of the Structured Clinical Interview (SCID) was used as gold standard. MDQ screened 24.1% of depressive patients as bipolar, vs. 12.6% according to SCID. For a cut-off point score of 7 positive answers, sensitivity was 72.7% (95% CI = 63.3 - 82.1) and specificity 82.9% (95% CI = 74.9-90.9). Likelihood ratio of positive and negative tests were 4,252 y 0,329 respectively. The small sample size reduced the power of the study to 62%. Sensitivity and specificity of the MDQ were high for screening bipolar disorder in patients with major depression, and similar to the figures obtained in stable patients. This study confirms that MDQ is a useful instrument in the daily clinical assessment of depressive patients.
    Full-text · Article · Feb 2008 · Clinical Practice and Epidemiology in Mental Health
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    • "To select the appropriate bipolar patient for long-term treatment with lithium the existing findings on lithium's anti-suicidal effect could be taken into account as well as atypical features of the course of the disease. We have worked on suitable algorithms, and the German Association of Bipolar Disorders (DGBS) has presented them in its recently published White Book (Berghöfer, Bauer & Müller-Oerlinghausen, 2002). Figure 1 illustrates the use of the discriminating criterion " suicidality (suicide attempts in the history of a patient) " . "
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    ABSTRACT: The article reviews the existing evidence and the concept of the anti-suicidal effect of lithium long-term treatment in bipolar patients. The core studies supporting the concept of a suicide preventive effect of lithium in bipolar patients come from the international research group IGSLI, from Sweden, Italy, and recently also from the U.S. Patients on lithium possess an eight- time lower suicide risk than those off lithium. The anti-suicidal effect is not necessarily coupled to lithium's episode suppressing efficacy. The great number of lives potentially saved by lithium adds to the remarkable benefits of lithium in economical terms. The evidence that lithium can effectively reduce suicide risk has been integrated into modern algorithms in order to select the optimal maintenance therapy for an individual patient.
    Full-text · Article · Feb 2005 · Archives of Suicide Research
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