Total healthcare cost savings through improved bipolar I disorder identification using the Rapid Mood Screener in patients diagnosed with major depressive disorder

Figures & data

Figure 1. Model structure.

Table 1. Summary of epidemiology, RMS, and cost inputs.

Parameter	Base case value	Low estimate	High estimate	Source
Population and diagnosis inputs
Number of MDD patients	1000	900	1100	Assumption
Prevalence of BP-I misdiagnosis	24.3%	20%	25%	Angst et al.^13
RMS sensitivity	88%	79%	97%	McIntyre et al.^16
RMS specificity	80%	72%	88%	McIntyre et al.^16
Annual probability of obtaining a correct BP-I diagnosis in usual care for patients who incorrectly screened negative on the RMS
Year 1	20%	18%	22%	Hirschfeld et al.^9
Year 2	7%	6%	8%	Hirschfeld et al.^9
Year 3	10%	9%	11%	Hirschfeld et al.^9
Probability of specialist follow-up with positive screening result	100%	75%	100%	Assumption
Annual probability of correct diagnosis among patients referred to specialist after positive screen on the RMS	100%	90%	100%	Assumption
Annual probability of obtaining a correct BP-I diagnosis in usual care for unscreened patients
Year 1	20%	18%	22%	Hirschfeld et al.^9
Year 2	7%	6%	8%	Hirschfeld et al.^9
Year 3	10%	9%	11%	Hirschfeld et al.^9
Cost inputs
Cost of screening with RMS	$0	$0	$0	Assumption
Cost of psychiatric follow-up^a	$201.68	$181.52	$221.85	CMS^21
Annual cost of correctly diagnosed bipolar I disorder^b
Year 1	$10,430	$9387	$11,473	McIntyre et al.^12
Year 2	$5589	$5030	$6148	McIntyre et al.^12
Year 3	$2995	$2696	$3295	McIntyre et al.^12
Annual cost of BP-I patients misdiagnosed as MDD^c
Year 1	$18,338	$16,505	$20,172	McIntyre et al.^12
Year 2	$12,047	$10,842	$13,251	McIntyre et al.^12
Year 3	$7913	$7122	$8704	McIntyre et al.^12
Annual cost of correctly diagnosed MDD	$1115	$1003	$1226	AbbVie 2017^d
Annual cost of MDD patients misdiagnosed as bipolar I disorder	$1115	$1003	$1226	Assumption

CMS, Centers for Medicare and Medicaid Services; MDD, major depressive disorder; USD, US dollars.

^a2020 USD.

^bAnnual cost extrapolated using exponential fit based on the average annual cost of $9792 and average annual cost over entire follow up $6749 over 893 d, inflated to 2021 USD.

^cAnnual cost extrapolated using exponential fit based on the average annual cost of $17,217 and average annual cost over entire follow up $12,901 over 937 d, inflated to 2021 USD.

^dInternal claims analysis, data on file, AbbVie, 2017.

Table 2. RMS screening versus no screening: number of correct diagnoses.

	Year 1	Year 2	Year 3
Number of patients with correct diagnosis (bipolar I disorder or MDD)
RMS	977	978	981
No screening	806	819	837
Difference	171	159	143

MDD, major depressive disorder; RMS, Rapid Mood Screener.

Figure 2. Average per-patient cost savings for RMS screening versus no screening.

Figure 3. One-way sensitivity analysis results: total per person cost difference over 3 years.

Angst J, Sellaro R, Stassen HH, et al. Diagnostic conversion from depression to bipolar disorders: results of a long-term prospective study of hospital admissions. J Affect Disord. 2005;84(2–3):149–157.

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McIntyre RS, Patel MD, Masand PS, et al. The rapid mood screener (RMS): a novel and pragmatic screener for bipolar I disorder. Curr Med Res Opin. 2021;37(1):135–144.

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Hirschfeld RM, Lewis L, Vornik LA. Perceptions and impact of bipolar disorder: how far have we really come? Results of the national depressive and manic-depressive association 2000 survey of individuals with bipolar disorder. J Clin Psychiatry. 2003;64(2):161–174.

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Centers for Medicare and Medicaid Services. CMS physician fee schedule. 2021 [cited 2021 Mar 29]. Available from: https://www.cms.gov/medicare/physician-fee-schedule/

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