1
|
Pan YJ, Kuo KH, Chan HY, Yeh LL. Cost-effectiveness and cost-utility analysis of outpatient follow-up frequency in relation to three-year mortality in discharged patients with bipolar disorder. Psychiatry Res 2019; 272:61-68. [PMID: 30579183 DOI: 10.1016/j.psychres.2018.12.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/15/2018] [Accepted: 12/11/2018] [Indexed: 11/29/2022]
Abstract
There is a lack of clarity in terms of cost-effectiveness and cost-utility comparisons across different outpatient (OPD) follow-up patterns in discharged patients with bipolar disorder (BD). In this study, adult patients hospitalised for BD treatment (n = 1,591) were identified from the National Health Insurance Research Database in Taiwan. With survival as the effectiveness measure and quality-adjusted life years (QALYs) as the utility measure, a cost-effectiveness and cost-utility analysis was conducted over the 3-year follow-up period by post-discharge frequency of OPD visits. Compared to those making 1-7, 8-12 and 18 or more OPD visits, BD patients making 13-17 OPD visits within the first year after discharge had the lowest psychiatric and total healthcare costs over the follow-up period. With survival status as the effectiveness outcome, making 13-17 OPD visits was more likely to be the cost-effective option, as revealed by incremental cost-effectiveness ratios. Cost-utility analysis demonstrated that having 13-17 OPD visits was probably the more cost-effective option when considering QALYs; for instance, if society was willing to pay NTD1.5 million for one additional QALY, there was a 75.2% (psychiatric costs) to 77.4% (total costs) likelihood that 13-17 OPD visits was the most cost-effective option. In conclusion, post-discharge OPD appointments with a frequency of 13-17 visits within the first year were associated with lower psychiatric and total healthcare costs in the subsequent 3 years. Having an adequate outpatient follow-up frequency was likely to be cost-effective in the management of discharged patients with BD in this real-world setting.
Collapse
Affiliation(s)
- Yi-Ju Pan
- Department of Psychiatry, Far Eastern Memorial Hospital, No.21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City 220, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Kuei-Hong Kuo
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Medical Image, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hung-Yu Chan
- Department of General Psychiatry, Taoyuan Psychiatric Center, Taoyuan, Taiwan; Department of Psychiatry, National Taiwan University Hospital and School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ling-Ling Yeh
- Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan
| |
Collapse
|
2
|
Berk L, Hallam KT, Venugopal K, Lewis AJ, Austin DW, Kulkarni J, Dodd S, de Castella A, Fitzgerald PB, Berk M. Impact of irritability: a 2-year observational study of outpatients with bipolar I or schizoaffective disorder. Bipolar Disord 2017; 19:184-197. [PMID: 28470892 DOI: 10.1111/bdi.12486] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 03/12/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Many people experience irritability when manic, hypomanic, or depressed, yet its impact on illness severity and quality of life in bipolar and schizoaffective disorders is poorly understood. This study aimed to examine the relationship between irritability and symptom burden, functioning, quality of life, social support, suicidality, and overall illness severity in a naturalistic cohort of people with bipolar I or schizoaffective disorder. METHODS We used data from 239 adult outpatients with bipolar I or schizoaffective disorder in the Bipolar Comprehensive Outcomes Study (BCOS) - a non-interventional observational study with a 2-year follow-up period. Baseline demographic and clinical characteristics of participants with and without irritability were compared. A mixed-model repeated measures analysis was conducted to examine the longitudinal effect of irritability on clinical and quality-of-life variables over follow-up using significant baseline variables. RESULTS At baseline, 54% of participants were irritable. Baseline irritability was associated with illness severity, mania, depression, psychotic symptoms, suicidality, poor functioning, and quality of life, but not diagnosis (schizoaffective/bipolar disorder). Participants with irritability were less likely to have a partner and perceived less adequate social support. On average, over follow-up, those with irritability reported more symptoms, functional impairment, and suicidality. Furthermore, the effects of irritability could not be fully explained by illness severity. CONCLUSIONS Irritability was associated with more negative symptomatic, functional, and quality-of-life outcomes and suicidality. The identification, monitoring, and targeted treatment of irritability may be worth considering, to enhance health and wellbeing outcomes for adults with bipolar and schizoaffective disorders.
Collapse
Affiliation(s)
- Lesley Berk
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Vic., Australia.,Department of Psychiatry, University of Melbourne, Parkville, Vic., Australia.,Melbourne School of Global and Population Health, University of Melbourne, Parkville, Vic., Australia
| | - Karen T Hallam
- Department of Psychology, The University of Melbourne, Parkville, Vic., Australia.,Department of Psychology, Victoria University, Melbourne, Vic., Australia
| | - Kamalesh Venugopal
- South Australian Department for Health and Ageing, Adelaide, SA, Australia
| | - Andrew James Lewis
- School of Psychology & Exercise Science, Murdoch University, Murdoch, WA, Australia.,Harry Perkins Institute of Medical Research, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - David W Austin
- School of Psychology, Faculty of Health, Deakin University, Burwood, Vic., Australia
| | - Jayashri Kulkarni
- Monash Alfred Psychiatry Research Centre (MAPrc), Monash University Central Clinical School and The Alfred, Melbourne, Vic., Australia
| | - Seetal Dodd
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Vic., Australia.,Department of Psychiatry, University of Melbourne, Parkville, Vic., Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Vic., Australia
| | - Anthony de Castella
- Monash Alfred Psychiatry Research Centre (MAPrc), Monash University Central Clinical School and The Alfred, Melbourne, Vic., Australia
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre (MAPrc), Monash University Central Clinical School and The Alfred, Melbourne, Vic., Australia
| | - Michael Berk
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Vic., Australia.,Department of Psychiatry, University of Melbourne, Parkville, Vic., Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Vic., Australia.,Florey Institute for Neuroscience and Mental Health, Parkville, Vic., Australia
| |
Collapse
|
3
|
Anaya C, Torrent C, Caballero FF, Vieta E, Bonnin CDM, Ayuso-Mateos JL. Cognitive reserve in bipolar disorder: relation to cognition, psychosocial functioning and quality of life. Acta Psychiatr Scand 2016; 133:386-98. [PMID: 26719018 DOI: 10.1111/acps.12535] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Cognitive reserve (CR) is a concept that was postulated as a protective factor for some clinical symptoms after the observation that there is not a direct relationship between the degree of brain damage and its clinical manifestation. This study aimed to explore the association between CR and the main outcomes in bipolar disorder (BD): cognitive functions, psychosocial functioning and perceived quality of life. METHOD A sample of 224 euthymic bipolar patients was assessed with a neuropsychological battery, the Functioning Assessment Short Test and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). CR was calculated through three proxies: estimated premorbid Intelligent Quotient, educational level and occupational attainment. Relationships between CR and cognitive functions, psychosocial functioning and quality of life were assessed by multiple linear regression models. RESULTS Higher CR was associated with better cognitive functioning (P < 0.001 in processing speed, working memory, verbal and visual memory, and executive function; P = 0.026 in attention) and better psychosocial functioning (P = 0.008). For quality of life, CR was positively associated with the physical component of the SF-36 (P = 0.016) but negatively associated with the mental component (P = 0.004). CONCLUSION The results suggest that CR may play an important role in the course and prognosis of bipolar patients and it should be considered in both clinical and research settings related to BD.
Collapse
Affiliation(s)
- C Anaya
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Department of Psychiatry, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - C Torrent
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Bipolar Disorders Unit, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - F F Caballero
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain
| | - E Vieta
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Bipolar Disorders Unit, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - C Del Mar Bonnin
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Bipolar Disorders Unit, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - J L Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain
| | | |
Collapse
|
4
|
Xiao L, Gao Y, Zhang L, Chen P, Sun X, Tang S. Validity and reliability of the Brief version of Quality of Life in Bipolar Disorder" (Bref QoL.BD) among Chinese bipolar patients. J Affect Disord 2016; 193:66-72. [PMID: 26766036 DOI: 10.1016/j.jad.2015.12.074] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 11/23/2015] [Accepted: 12/30/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previous literatures on quality of life (QoL) in bipolar disorder (BD) strongly suggested that a disease-specific QoL measure for patients with BD should be developed to evaluate QoL more specifically and reliably. To our knowledge, "Quality of Life in Bipolar Disorder" (QoL.BD) is the first and only questionnaire produced to specifically measure QoL in people with BD. In China, there is no disease-targeted measure available to specifically measure QoL in Chinese patients with BD. OBJECTIVE The aim of the study is to revise and validate the brief version of the QoL.BD (Bref QoL.BD ) into Chinese version. METHODS All the items of the Bref QoL.BD was translated into Chinese language, using the Brislin translation mode. The questionnaire was administered to a total sample of 231 subjects, including 101 BD patients and 130 healthy controls, to test the psychometric properties of Bref QoL.BD (e.g. internal consistency, retest reliability, content validity, item analysis, confirmatory factor analysis, criterion validity, convergent validity, discriminative validity and feasibility). RESULTS The Chinese version of the Bref QoL.BD had very high internal consistency (Cronbach's alpha=0.815) and retest reliability (intraclass correlation coefficient (ICC )=0.808). Confirmatory factor analysis (CFA) validated the original one-factor structure. The direction and magnitude of correlations with 36-item Short-Form Health Survey (SF-36; rs= 0.313, P<0.001) and 17-Hamilton Depression Rating Scale(HAMD; rs=-0.328, P <0.001) suggesting the criterion validity and convergent validity, respectively. The scores of Bref QoL.BD in subsyndromic BD group (HDRS≥4 and BRMS≥3), asymptomatic BD group (HDRS≤3 and BRMS≤2) and the control group significantly decreased successively, suggesting a discriminative validity of the instrument. LIMITATIONS Cross-sectional design and a small sample size from only one tertiary care center. And BD patients enrolled were euthymic, excluding the acute BD patients. CONCLUSIONS The Chinese version of the Bref QoL.BD is a feasible, reliable and valid tool for the assessment of QoL for Chinese BD patients.
Collapse
Affiliation(s)
- Lin Xiao
- School of Nursing, Southern Medical University, Guangdong Province, 510515, China.
| | - Yulin Gao
- School of Nursing, Southern Medical University, Guangdong Province, 510515, China
| | - Lili Zhang
- School of Nursing, Southern Medical University, Guangdong Province, 510515, China.
| | - Peiyun Chen
- School of Nursing, Southern Medical University, Guangdong Province, 510515, China
| | - Xiaojia Sun
- School of Nursing, Southern Medical University, Guangdong Province, 510515, China
| | - Siyuan Tang
- Nursing School of Central South University, Hunan Province, 410013, China.
| |
Collapse
|
5
|
Quality of life in bipolar and schizoaffective disorder--a naturalistic approach. Compr Psychiatry 2014; 55:1540-5. [PMID: 24962450 DOI: 10.1016/j.comppsych.2014.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 05/18/2014] [Accepted: 05/19/2014] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the health-related quality of life (HRQoL) in bipolar type I (BD I) and schizoaffective (SQA) patients during a 2-year period in a naturalistic study. METHODS This study was based on the data generated by the Bipolar Comprehensive Outcome Study, a prospective, non-interventional, observational study of participants with BD I and SQA disorder. Mixed-Model Repeated Measures Analysis was used to analyze changes in the SF-36 and EQ-5D. RESULTS Participants exhibited low health status at baseline with SF-36 mean scores of 46.7±10.5 and 36.9±12.9 (best imaginable health=100, normal population≈50) for physical and mental components, respectively. No significant differences were found between the ratings of the BD I and SQA patients on HRQoL. The SF-36 SMC improved significantly over 24 months although SPC scores remained consistent across the study. On the whole, the lowest SMC score was observed among the depressed patients (38.20), followed by the patients with a mixed state (39.01) and the manic patients (39.83). LIMITATIONS The observational design may have limited the causal relationships and the generalizability within the current findings. CONCLUSIONS HRQoL was significantly impaired in all stages of BD and SQA when compared to the general population. The impairment of HRQoL was most pronounced in the depressed state, followed by the mixed state and then the manic state. The euthymic patients showed the least impairment. In addition, patients showed a global improvement in their mental health satisfaction over the 2 years follow up period.
Collapse
|