Place of care and costs associated with acute episodes and remission in bipolar I disorder

Figures & data

Table 1. Patient demographics and baseline characteristics.

Characteristic	Acute episodes
	Manic/Mixed	Depressive	Remission
	(n = 41,516)	(n = 47,763)	(n = 8,143)
Age at index date, mean (SD)	42.8 (17.0)	43.3 (15.8)	44.9 (15.9)
Median (IQR)	43 (26–55)	44 (30–55)	46 (32–57)
Male, n (%)	16,273 (39.2)	15,624 (32.7)	3,030 (37.2)
Payer type, n (%)
Commercial	37,228 (89.7)	43,626 (91.3)	7,332 (90.0)
Medicare	4,288 (10.3)	4,137 (8.7)	811 (10.0)
Health plan type, n (%)
Comprehensive	3,290 (7.9)	3,400 (7.1)	601 (7.4)
EPO	471 (1.1)	498 (1.0)	76 (0.9)
HMO	5,630 (13.6)	6,272 (13.1)	1,060 (13.0)
POS	3,280 (7.9)	3,828 (8.0)	609 (7.5)
PPO	23,381 (56.3)	27,118 (56.8)	4,551 (55.9)
CDHP/HDHP	3,631 (8.7)	4,639 (9.7)	937 (11.5)
Missing	1,833 (4.4)	2,008 (4.2)	309 (3.8)
Region, n (%)
Northeast	9,875 (23.8)	9,862 (20.7)	1,572 (19.3)
North central	10,631 (25.6)	11,956 (25.0)	1,900 (23.3)
South	12,703 (30.6)	15,918 (33.3)	2,720 (33.4)
West	7,132 (17.2)	8,205 (17.2)	1,342 (16.5)
Unknown	405 (1.0)	464 (1.0)	83 (1.0)
CCI, mean (SD)	0.17 (0.79)	0.24 (0.91)	0.31 (1.01)

Abbreviations. CCI, Charlson Comorbidity Index; CDHP, Consumer Directed Health Plan; EPO, Exclusive Provider Organization; HDHP, High Deductible Health Plan; HMO, Health Maintenance Organization; IQR, interquartile range; POS, Point of Service; PPO, Preferred Provider Organization; SD, standard deviation.

Figure 1. Place of care for (A) manic/mixed acute episodes and (B) depressive acute episodes of bipolar I disorder. Abbreviations. CLZ, clozapine use; SD, standard deviation.

Figure 2. Acute mental health-related medical costs for (A) manic/mixed acute episodes and (B) depressive acute episodes of bipolar I disorder.

^aInpatient medical costs include claims during an inpatient stay and include a 3-week (manic/mixed) or 6-week (depressive) observation period post-episode start.

^bOutpatient medical costs include physician visits, lab visits, and other outpatient visits during a 2-week (manic/mixed) or 4-week (depressive) observation period for identifying outpatient claims.

Figure 3. Mental health-related pharmacy^a costs for (A) manic/mixed acute episodes and (B) depressive acute episodes of bipolar I disorder.

^aPharmacy costs are for both inpatient and outpatient episode types.

^bIncludes lithium, olanzapine-fluoxetine, carbamazepine, valproate (divalproex and valproic acid), lamotrigine, and electroconvulsive therapy.

^cOther mental health medications (listed in Supplemental Table 3) are for pharmacy fills excluding antipsychotics (atypical and typical) and other bipolar treatments. Abbreviations. AA, atypical antipsychotic; MH, mental health.

Figure 4. 3-month outpatient remission costs.

^aMedical costs include physician visits, lab visits, and other outpatient visits.

^bPharmacy costs exclude oral or injectable typical and atypical antipsychotics and other bipolar treatments.

Data availability statement

This study was exempt from Ethics Committee approval and institutional review because it is a retrospective analysis that used anonymized and de-identified data certified as fully compliant with United States patient confidentiality requirements set forth in the Health Insurance Portability and Accountability Act of 1996. Allergan (prior to its acquisition by AbbVie) obtained permission to access and use the IBM MarketScan data used in the analysis through licensing agreements.