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J Affect Disord. 2007 Jan;97(1-3):171-9. Epub 2006 Jul 24.

The impact of unrecognized bipolar disorders among patients treated for depression with antidepressants in the fee-for-services California Medicaid (Medi-Cal) program: a 6-year retrospective analysis.

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  • 1Department of Pharmaceutical Economics and Policy, School of Pharmacy, University of Southern California, Los Angeles, CA 90089-9004, USA. jmccombs@usc.edu

Abstract

INTRODUCTION:

The cost of unrecognized bipolar disorders over time is unknown.

METHODS:

Ten years of data from the California Medicaid program were used to identify depressed patients initiating new episodes of antidepressant therapy and with 6+ years of post-treatment data. Recognized bipolar (RBP) patients received a BP diagnosis or used mood stabilizers in the pre-index period. Unrecognized bipolar (UBP) patients received an initial BP diagnosis or used a mood stabilizer in the post-index period. Depression-only (MDD) patients had no BP diagnosis or mood stabilizer use. Three analyses were conducted: (1) regression models of cost per year, (2) a regression model of aggregate cost over 6 years and (3) a time trend analysis of the costs for UBP patients.

RESULTS:

14,809 patients were identified: RBP 14.5%, UBP 28.2% and MDD 57.3%. The growth in costs per month for UBP patients over 6 years (171%) far exceeds the growth for RBP and MDD patients (82% and 95%, respectively). RBP and MDD patients cost 2316 dollars and 1681 dollars less per year in the 6th year relative to UBP patients (p<0.0001 for both estimates). The cost per month increased by 91 dollars for each month of delayed diagnosis (p=0.011). Costs for UBP patients increased by 10 dollars per month prior to their initial BP diagnosis (p<0.001) and by -1.01 dollars thereafter (p=0.006 for the change in slope).

LIMITATIONS:

Classification of patients based on diagnosis or mood stabilizer use using paid claims data is inexact.

CONCLUSIONS:

Early diagnosis of bipolar disorders may significantly reduce health care cost.

PMID:
16860396
[PubMed - indexed for MEDLINE]
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