Coût du trouble bipolaire : revue de la littérature

One-year post-hospital medical costs and relapse rates of bipolar disorder patients in Taiwan: a population-based study

OBJECTIVES

  We examined a nationwide population-based dataset of patients with bipolar disorder (BD) hospitalized in Taiwan, with our analyses focusing on one-year medical costs and relapse rates.

METHODS

  The data for this study, covering the years 2006 and 2007, were obtained from the Taiwan National Health Insurance (NHI) claims database. The study sample comprised BD patients who were discharged from hospitals between January 1 and December 31, 2006. Annual medical costs and relapse rates were described; the Kaplan-Meier method and the generalized linear models were carried out to examine the risk factors associated with cases of relapse.

RESULTS

  The annual medical costs associated with relapses among the study sample were found to be approximately 7.6 times the average per-capita NHI expenditure in Taiwan in 2006 (US$4,354 versus US$574), with a one-year relapse rate of 55%. Those patients between 20 and 60 years old with a medication possession ratio of <80 and with depressive episodes during the recruitment period were identified as being at risk of relapse.

CONCLUSION

  Bipolar disorder, which is a very costly disease, is associated with both poor medication adherence rates and frequent recurrences. Targeting drug adherence issues during maintenance treatment may well provide a valuable opportunity to reduce the risk of such recurrences.

Factors associated with treatment nonadherence among US bipolar disorder patients

OBJECTIVE

Since sustained treatment-adherence is often problematic and may limit clinical outcomes among bipolar disorder (BPD) patients, we sought risk factors to guide clinical prediction of nonadherence.

METHODS

Data were from a 2005 US national sample providing questionnaire responses by 131 randomly selected prescribing psychiatrists and their adult BPD patients. We contrasted demographic and clinical factors in treatment-adherent versus nonadherent patients (strictly defined as missing > or =1 dose within 10 days) in univariate analyses followed by multivariate logistic-regression modeling.

RESULTS

Of 429 DSM-IV BPD patients (79% type-I; 62% women; 17% minorities), 34% reported missing > or = 1 dose of psychotropic medication within 10 days, 20% missed entire daily doses at least once, and only 2.5% missed all doses for 10 days. However, their prescribing psychiatrists considered only 6% as treatment-nonadherent. Factors significantly associated with nonadherence in multivariate modeling ranked: alcohol-dependence > youth > greater affective morbidity > various side effects > or = comorbid obsessive-compulsive disorder > or = recovering from mania-hypomania. Unrelated were sex, diagnostic subtype, and other comorbidities. Since most patients received > or = 2 psychotropics, potential relationships between treatment-complexity and adherence were obscured.

CONCLUSIONS

Prevalent treatment-nonadherence among American BPD patients, and striking underestimation of the problem by prescribing clinicians may encourage increasingly complex treatment-regimens of untested value, but added expense, risk of adverse effects, and uncertain impact on treatment-adherence itself.