Pharmacy and Therapeutics - January 2008 - (Page 26) Impact of Bipolar Disorder on the Family Table 3 Annualized Unadjusted Average Health Care Utilization and Costs Bipolar Families No. of Families 43,448 Mean SD Outpatient visits per family year BPD-related Non–BPD-related Inpatient visits per family year BPD-related Non–BPD-related No. of prescriptions per family year BPD-related Non–BPD-related Matched Families 122,769 Mean SD P <0.001 Outpatient cost <0.001 BPD-related <0.001 Non–BPD-related No. of Families Bipolar Families 43,448 Mean $2,417 $227 $2,189 $762 $151 $611 SD $2,305 $551 $2,021 $1,860 $656 $1,487 Matched Families 122,769 Mean SD P 24.26 28.85 8.06 10.9 2.45 4.08 0.00 21.81 23.14 8.06 10.9 1.14 0.15 0.99 2.86 0.33 0.39 0.00 2.01 0.33 $786 $2,813 <0.001 $0 <0.001 $786 $2,813 <0.001 $187 $0 $187 $805 <0.001 <0.001 $805 <0.001 0.91 <0.001 Inpatient cost <0.001 BPD-related 0.91 <0.001 Non–BPD-related 24.29 33.91 7.83 15.43 <0.001 Prescription cost 1.92 2.26 0.00 <0.001 BPD-related 22.38 28.65 7.83 15.43 <0.001 Non–BPD-related Total health care cost BPD-related Non–BPD-related $1,485 $214 $1,271 $2,238 $571 $2,127 $403 $1,115 <0.001 $0 <0.001 $403 $1,115 <0.001 $4,664 $592 $4,072 $5,238 $1,376 $3,055 <0.001 $941 $0 <0.001 $2,930 $1,376 $3,055 <0.001 * Families containing a member with bipolar disorder (BPD) include the resource use and costs for the individual with the diagnosis of BPD. SD = standard deviation. Although it is possible that the stress of caregiving contributes to more frequent treatment for mental and physical comorbidities, other explanations are possible. An alternate hypothesis posits that parents in families with a bipolar member have more regular contact with the health care system because of consultations for their children. If these parents interact with the system more often, they have more opportunities to discuss and receive attention for their own health concerns, compared with parents in the control group. Other possible hypotheses for the increased usage and costs of health care services include the ability of the family to cope with the illness23–25 as well as the shared genetic liability for mood disorders and comorbid physical conditions associated with bipolar disorder.26 Even though the bipolar families had more comorbid diagnoses, there was a similar distribution of diagnoses among the study groups, with a few exceptions. Pregancy and newborn diagnoses were less common in bipolar families; such families have been noted for individuals with bipolar disorder in previous research.27 The increased use of alcohol and drugs among families with a bipolar member may be directly attributable to bipolar disorder; the correlations between bipolar disorder and these diagnoses have been well documented.28 The trend in the Injuries, Poison, and Toxic Effect of Drugs MDC (see Table 2) may be reflective of self-injurious behavior such as suicidal attempts.29 Adding to the hypothesis that the effect of bipolar disorder extends beyond the individual with the diagnosis are the find- ings that children with the diagnosis had the lowest per-member costs. However, the costs of families with a bipolar child were 30% higher than for families with an adult bipolar member. This increase in cost appears to be driven by the use of health care resources by parents. The health care costs of parents, particularly mothers, with bipolar children are substantially affected, more so than those of the spouses of individuals with bipolar disorder, possibly because of the psychological stress associated with caring for a child with a disability. Most informal caregivers of children are mothers,20 thereby augmenting this effect. The impact of bipolar disorder also appears to intensify with the number of family members affected; the costs for families with a child and parent carrying the diagnosis cost are almost 500% higher than those for their matched controls. The high costs incurred by these families make them ideally suited for case management, which can reduce the level of mania symptoms.30 LIMITATIONS OF THE STUDY As with all research, some limitations may need to be considered. Although our analysis used a unique and rich data set, analyses based on insurance claims data are limited by several factors, including: • the possibility of an inaccurate diagnosis. • coding inaccuracies, which might be relevant in bipolar disorder. 26 P&T® • January 2008 • Vol. 33 No. 1
For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.