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At least 919 records · Page 51Linked to original sources
PubMed2004

The impact of unrecognized bipolar disorders for patients treated for depression with antidepressants in the fee-for-services California Medicaid (Medi-Cal) program.

BACKGROUND: This study compares hospital use, suicide risk and health care costs of antidepressant patients with recognized bipolar disorders (recognized-BP) and unrecognized bipolar disorders (unrecognized-BP) with non-bipolar (non-BP) patients. METHODS: Data from the California Medicaid (Medi-Cal) program were used to identify 25,460 adults with a new episode of antidepressant therapy. Recognized-BP patients received either a bipolar (BP) diagnosis or a mood stabilizer (MS) on or before the initiation of antidepressant therapy. Unrecognized-BP patients received a BP diagnosis or MS therapy after antidepressant initiation. Non-BP patients had no BP diagnosis and no MS use. Multivariate models were used to estimate marginal risks and costs across groups. RESULTS: Recognized-BP and unrecognized-BP represented 14.9% and 6.2% of all antidepressant users, respectively. Less than half of recognized-BP patients used a MS medication in conjunction with their antidepressant. Unrecognized-BP patients were nearly four times more likely to attempt suicide and 50% more likely to be hospitalized than non-BP patients. Recognized-BP patients were at lower risk for attempted suicide and hospitalization relative to unrecognized-BP patients. Unrecognized-BP patients experienced higher 1-year total costs relative to non-BP patients (USD 995, p<0.01) and recognized-BP patients (USD 682, p<0.05). LIMITATIONS: Clinically relevant medical records data were not available making the classification of patients as unrecognized-BP, recognized-BP and non-BP imprecise. CONCLUSIONS: Unrecognized-BP is both common and costly. More than half of all recognized-BP patients do not use an MS at the time they initiated antidepressant therapy. More effort is needed to provide early and correct diagnosis and effectively treat both recognized-BP and unrecognized-BP patients.

Adult↗
PubMed2006

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.

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.

Adult↗