Pharmacy and Therapeutics - January 2008 - (Page 15) Impact of Bipolar Disorder on the Family Utilization and Cost of Health Care Resources Mar y Lou Chatterton, PharmD, Xiongkan Ke, MS, Barbara Edelman Lewis, PhD, MHA, Krithika Rajagopalan, PhD, and Arthur Lazarus, MD, MBA ABSTRACT Objective: Our retrospective analysis compared costs and patterns of health care utilization by families that included a member with bipolar disorder (“bipolar families”) and by families without serious psychiatric disease (“control families”). Methods: We used the MarketScan Commercial Claims and Encounters Database covering January 1998 through December 2002. International Classification of Diseases (ICD-9CM) codes were used to identify individuals with bipolar disorder and link them to their family members. Bipolar families were matched in a ratio of 1:3 to families without a serious mental illness. We calculated and statistically compared the mean annual use of resources and health care costs for each group, including the individual with bipolar disorder. We used a multivariate model to test the effect of demographic and health care variables on the impact of total health care expenditures. Results: Families with a member with bipolar disorder (n = 43,448), compared with matched families (n = 122,769), made significantly more outpatient physician visits (24 vs. eight; P < 0.001), more inpatient hospital stays (1 vs. 0.3; P < 0.001), and more prescription medications (24 vs. 7.8; P < 0.001). Total annual health care costs were more than three-fold higher for bipolar families ($4,664), compared with matched families ($1,376) (P < 0.001). The multivariate model controlled for family size and comorbidities, indicating significantly higher total health care costs for families with one or more persons with bipolar disorder than for matched families without serious mental illness. Conclusion: These results indicate that bipolar disorder has a significant financial impact on families in addition to the individual with the diagnosis. INTRODUCTION Bipolar disorder is a serious, chronic psychiatric disease characterized by a dysregulation of mood.1 Like other serious mental illnesses, it significantly impairs an individual’s functioning, well-being, and productivity, adding to medical costs.2 Economic analyses estimate total annual costs at $24 to $45 billion.3–6 The effect on the family has been incorporated into Dr. Chatterton is Vice President of MLG Consulting Services, Inc., in Chadds Ford, Pennsylvania. Xiongkan Ke is a Senior Statistical Programmer at AstraZeneca in Wilmington, Delaware. Dr. Lewis is Director of Health Economics and Outcomes Research at Eisai Corporation of North America in Woodcliff Lake, New Jersey. Dr. Rajagopalan is Director of Global Health Economics at Biogen Idec, in Cambridge, Massachusetts. Dr. Lazarus is Senior Director of Clinical Research at AstraZeneca. some of these economic analyses through an estimation of indirect costs, including the cost of caregivers’ time and lost work productivity resulting from caregiving. These studies have reported that indirect costs represent a substantial portion (35%–83%) of total costs.4–6 However, the effect of mental illness on the family may exceed the cost of a caregiver’s time away from work. Several studies have reported associations between providing care for a family member with a mental illness and the mental and physical strain on caregivers themselves.7–10 Dyck et al. reported that mental illness affects the physical health of caregivers by showing an association between the occurrence of infectious illness episodes in caregivers and the severity of schizophrenia symptoms exhibited by the patient.11 In studies of serious mental illness (bipolar disorder, schizophrenia, major depression) the physical health, health care costs, and work productivity of the entire family are affected by the mental and physical strain on family members involved in caregiving.12,13 Gallagher and Mechanic observed that sharing a household with a mentally ill person is associated with self-reported poorer physical health and a greater risk of hospitalization or visiting a physician.12 Using administrative data from a large regional health plan, Gianfrancesco et al. found that the costs of mental health care were 213% higher and other health care expenses were 7.4% higher for family members of individuals with bipolar disorder than those from a control group.13 A pilot study also suggested that paid caregivers of patients with dementia experience symptoms of depression and anxiety related to the degree of their involvement with the patient.14 Although the body of research regarding the effects of caregiving on physical health and health care costs is expanding, few studies have evaluated the effect of bipolar disorder on the use and costs of health care by families. Through a retrospective study, we sought to further quantify the impact of bipolar disorder on the use and costs of health care for families that included a member with a diagnosis of bipolar disorder, compared with families that did not include a member with a serious mental illness. METHODS The amount of health care resources used and health care costs for families containing an individual with bipolar disorder (“bipolar families”) were compared with health care costs of Disclosure: Research for this study was funded by AstraZeneca. At the time of the study, Dr. Chatterton was a paid consultant to AstraZeneca, and Dr. Lewis and Dr. Rajagopalan were employees at AstraZeneca. Mr. Ke is an employee of AstraZeneca, and Dr. Lazarus is an employee and stockholder at AstraZeneca. Accepted for publication November 21, 2007. Vol. 33 No. 1 • January 2008 • P&T® 15
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