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

ArticleinJournal of Affective Disorders 71(1-3):131-9 · October 2002with9 Reads
DOI: 10.1016/S0165-0327(01)00394-9 · Source: PubMed
Abstract
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.
    • "Wyniki przeprowadzonych badañ wskazuj¹ na to, ¿e im wiêkszy stopieñ compliance , tj. stosowania siê do zaleceñ lekarskich , tym ni¿sze koszty opieki nad pacjentami . Wniosek taki wydaje siê s³uszny, chocia¿by dlatego, ¿e prawid³owe stosowanie leków zmniejsza ryzyko pojawienia siê nowego epizodu manii lub depresji oraz zmniejsza nasilenie dzia³añ niepo¿¹danych leków [16]. Natomiast w 1991 roku koszty choroby maniakalno-depresyjnej woeród doros³ych Amerykanów wynios³y 45 miliardów dolarów. "
    [Show abstract] [Hide abstract] ABSTRACT: Bipolar disorder is a chronic mental disorder characterized by high mortalities. Because of the high costs of treatment (pharmacological, stationary and non-stationary psychiatric care) it appears as a challenge for health care systems. Studies show that the costs of care rise especially in the case of the comorbid disorders (eg. personality disorders). In the context of estimating the cost of treatment, analysis of the different patterns of pharmacotherapy is needed. Important for the level of total expenditure is also the treatment of adverse drug reactions. Analyzed in this paper studies indicate that the cost of treatment of bipolar disorders have a tendency to increase. Hope to stop this process more effective drugs that reduce the number of hospitalizations.
    Full-text · Article · Feb 2015 · AIDS and Behavior
    • "This review identified several factors associated with higher direct healthcare costs. These include: @BULLET BD I [9, 51, 52] @BULLET delayed diagnosis or misdiagnosis56575859 @BULLET frequent psychiatric interventions [41, 60, 61] @BULLET use of second-generation antipsychotics [40, 62] @BULLET non-adherence to antipsychotic treatment [46, 63, 64] @BULLET poor prognosis [10] @BULLET relapse [47] @BULLET multiple comorbidities [40, 43, 52, 62, 65] It is recognised that the costs of BD fall on many different parts of society other than the healthcare system, such as individuals with BD and their families, local councils, the tax bureau and the criminal justice system. Because only 26 % of included studies took a societal perspective, much less evidence is available about factors associated with higher societal costs: @BULLET BD I [9] @BULLET delayed diagnosis or misdiagnosis [58] @BULLET poor prognosis [10] Based on the above findings, substantial savings could potentially be achieved by increasing investment in the following areas: "
    [Show abstract] [Hide abstract] ABSTRACT: Background and objectives: Bipolar disorder (BD) may result in a greater burden than all forms of cancer, Alzheimer's disease and epilepsy. Cost-of-illness (COI) studies provide useful information on the economic burden that BD imposes on a society. Furthermore, COI studies are pivotal sources of evidence used in economic evaluations. This study aims to give a general overview of COI studies for BD and to discuss methodological issues that might potentially influence results. This study also aims to provide recommendations to improve practice in this area, based on the review. Methods: A search was performed to identify COI studies of BD. The following electronic databases were searched: MEDLINE, EMBASE, PsycInfo, Cochrane Database of Systematic Reviews, HMIC and openSIGLE. The primary outcome of this review was the annual cost per BD patient. A narrative assessment of key methodological issues was also included. Based on these findings, recommendations for good practice were drafted. Results: Fifty-four studies were included in this review. Because of the widespread methodological heterogeneity among included studies, no attempt has been made to pool results of different studies. Potential areas for methodological improvement were identified. These were: description of the disease and population, the approach to deal with comorbidities, reporting the rationale and impact for choosing different cost perspectives, and ways in which uncertainty is addressed. Conclusions: This review showed that numerous COI studies have been conducted for BD since 1995. However, these studies employed varying methods, which limit the comparability of findings. The recommendations provided by this review can be used by those conducting COI studies and those critiquing them, to increase the credibility and reporting of study results.
    Full-text · Article · Jan 2015
    • "Poor PSY medication adherence is also common among people with SMI; it has been estimated that 40 % of those with BD do not take their mood stabilizer as prescribed, and one third take less than 30 % of their medication [18]. Among persons with BD, nonadherence to PSY medications can lead to greater risk for manic and depressive episodes, decreased quality of life, suicide attempts, and hospitalization [19, 20] . This suggests HIV?/BD? "
    [Show abstract] [Hide abstract] ABSTRACT: HIV+ persons with co-occurring bipolar disorder (HIV+/BD+) have elevated rates of medication nonadherence. We conducted a 30-day randomized controlled trial of a two-way, text messaging system, iTAB (n = 25), compared to an active comparison (CTRL) (n = 25) to improve antiretroviral (ARV) and psychotropic (PSY) adherence and dose timing. Both groups received medication adherence psychoeducation and daily texts assessing mood. The iTAB group additionally received personalized medication reminder texts. Participants responded to over 90 % of the mood and adherence text messages. Mean adherence, as assessed via electronic monitoring caps, was high and comparable between groups for both ARV (iTAB 86.2 % vs. CTRL 84.8 %; p = 0.95, Cliff's d = 0.01) and PSY (iTAB 78.9 % vs. CTRL 77.3 %; p = 0.43, Cliff's d = -0.13) medications. However, iTAB participants took ARVs significantly closer to their intended dosing time than CTRL participants (iTAB: 27.8 vs. CTRL: 77.0 min from target time; p = 0.02, Cliff's d = 0.37). There was no group difference on PSY dose timing. Text messaging interventions may represent a low-burden approach to improving timeliness of medication-taking behaviors among difficult-to-treat populations. The benefits of improved dose timing for long-term medication adherence require additional investigation.
    Full-text · Article · Dec 2014
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