Characteristics, healthcare utilization and costs of bipolar disorder type I patients with and without frequent psychiatric intervention in a Medicaid population

Abstract

Objective:

To compare characteristics, healthcare resource utilization and costs of Medicaid bipolar disorder (BPD) type I (BP-I) patients with and without frequent psychiatric intervention (FPI).

Methods:

Adults with BP-I, ≥1 prescription claim for a mood stabilizer/atypical antipsychotic and 24 months’ continuous medical/prescription coverage were identified (MarketScan Medicaid database). Patients with ≥2 clinically significant events (CSEs) during a 12-month identification period had FPI. CSEs included emergency department (ED) visits or hospitalizations with a principal diagnosis of BPD, addition of a new medication to the first observed treatment regimen or ≥50% increase in BPD medication dose. Demographic and clinical characteristics were evaluated for the identification period, and healthcare utilization and costs for the 12-month follow-up. Multivariate generalized linear modeling and multivariate logistic regression, respectively, were used to evaluate the impact of FPI on all-cause and psychiatric-related costs and risk of psychiatric-related hospitalization and ED visit during follow-up.

Results:

Of 5,527 BP-I patients, 53% had FPI. Relative to patients without FPI, those with FPI were younger and more likely to be female, had higher adjusted all-cause (+US$3,232, p < 0.001) and psychiatric-related (+US$2,519, p < 0.001) costs and higher risk of hospitalization (adjusted odds ratio [OR] = 3.681, 95% confidence interval [CI] = 2.85–4.75) and ED visit (OR = 3.094, 95% CI = 2.55–3.76).

Limitations:

Analysis used a convenience sample of Medicaid enrollees in several geographically dispersed states, limiting generalizability. Analyses of administrative claims data depend on accurate diagnoses and data entry.

Conclusion:

BP-I patients with FPI incurred significantly higher healthcare resource utilization and costs during the follow-up period than those without FPI.

Key words::

• Bipolar I disorder
• Costs
• Frequent psychiatric intervention
• Medicaid
• Resource utilization

Transparency

Declaration of funding

Ortho-McNeil Janssen Scientific Affairs, LLC, funded this study.

Declaration of financial/other relationships

E.D. and E.B. have disclosed that at the time of this analysis, they were employees of Thomson Reuters, a company that was contracted by Ortho-McNeil Janssen Scientific Affairs, LLC, to conduct this study. E.M., J.C.C., R.D. and C.C. have disclosed that they are employees of Ortho-McNeil Janssen Scientific Affairs, LLC, and Johnson & Johnson stockholders. J.T.H. has disclosed that he is an employee of Johnson & Johnson Pharmaceutical Research and Development and a Johnson & Johnson stockholder. W.M. has disclosed that he was an employee of Ortho-McNeil Janssen Scientific Affairs, LLC, at the time of this analysis.

Acknowledgments

The authors wish to acknowledge the technical and editorial support provided by Matthew Grzywacz, PhD, of ApotheCom. The authors also thank Kristina Yu-Isenberg, RPh, PhD, formerly an employee of Ortho-McNeil Janssen Scientific Affairs, LLC, for her input during the conduct of this study.

Notes

*MarketScan is a registered trademark of Thomson Reuters (Healthcare) Inc.