Birnbaum, HG

EQ, Wu

Greenberg, P

Huang, Z

Kessler, R

Parece, A

Victor, T

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273Abstracts
OBJECTIVES: The purpose of this study was to assess the direct
medical cost and indirect work-loss cost of bipolar disorder and
the comorbidities associated with this disease. METHODS: The
study sample was drawn from a de-identiﬁed administrative
claims database of approximately 1.8 million beneﬁciaries from
1999 to 2002, which included medical, drug, and disability
claims data. Patients between ages 18 and 65 years who had at
least 2 bipolar diagnoses, or 1 bipolar diagnosis and 1 prescrip-
tion for a mood stabilizer, were included in the bipolar sample
(N = 3499). A 1 :1 matching major depressive disorder (MDD)
control sample, and a 1 :1 matching nonbipolar/non-MDD
control sample with matching patient characteristics (age, sex,
employee status) were randomly selected. To assess excess annual
cost and comorbidities, we compared bipolar patients with the
matching samples. Cost analyses were conducted from an
employer’s perspective. All costs were adjusted to 2002 dollars
using Consumer Price Indices. T-tests or chi-square tests were
conducted to estimate statistical signiﬁcance. RESULTS: The
annual per patient medical cost of bipolar disorder was $7643;
the annual employee indirect cost was $2247. Compared with a
typical MDD patient, a bipolar patient experienced an incre-
mental health care cost of $1726 (P < 0.05), $741 (P < 0.05) for
drugs, $1237 (P < 0.05) for mental health services, $40 (P <
0.05) for emergency services, and $539 (P < 0.10) for employee
indirect work loss. Compared with nonbipolar/non-MDD
patients, bipolar patients had a higher risk of substance abuse
(relative risk [RR] = 11.6, P < 0.05), anxiety disorder (RR = 9.8,
P < 0.05), suicide/self-harm (RR = 26.0, P < 0.05), and
injury/accident (RR = 2.0, P < 0.05). The corresponding RRs for
comparisons with MDD patients were 6.4 (substance abuse), 
9.9 (anxiety disorder), 8.0 (suicide and self-harm), and 1.7
(injury/accident). CONCLUSIONS: Bipolar disorder is a costly
disease that is often associated with other mental conditions,
accidents, and suicide or self-harm.
PMH32
COMPARISON OF BIPOLAR DISORDER-RELATED COSTS
AMONG PATIENTS WITH AND WITHOUT COMORBID
DIABETES
Harley C1, Li H2, L’Italien G2, Hirschfeld R3,Walker A4, Carson W5
1Ingenix, Eden Prairie, MN, USA; 2Bristol-Myers Squibb, Wallingford,
CT, USA; 3University of Texas Medical Branch, Galveston,TX, USA;
4Ingenix, Auburndale, MA, USA; 5Otsuka America Pharmaceutical, Inc,
Princeton, NJ, USA
OBJECTIVES: While numerous studies have reported higher
prevalence of Type 2 diabetes mellitus in patients with bipolar
disorder, few have examined the impact of comorbid diabetes on
the costs associated with treating bipolar disorder patients in a
commercial health plan. This study explored differences in health
care costs between bipolar disorder patients with and without
comorbid diabetes. METHODS: Administrative claims data
from a large commercial health plan were used to identify preva-
lent bipolar disorder cases from medical claims based on a diag-
nosis code for bipolar disorder (ICD-9-CM diagnosis code
296.0x, 296.1x, 296.4x–296.7x) from 7/1/99 through 12/31/01.
Medical and pharmacy costs were calculated for a 365-day
period for continuously enrolled subjects. Costs were deﬁned as
bipolar-related if a bipolar diagnosis appeared in the primary
diagnosis position. Bipolar-related pharmacy costs were calcu-
lated from claims for mood stabilizers and atypical antipsy-
chotics. RESULTS: A total of 9459 bipolar disorder patients
were identiﬁed for analysis. Of these, 468 (5%) had a diabetes
diagnosis. Both median bipolar-related medical costs and median
pharmacy costs were lower for patients without diabetes com-
pared to patients with diabetes ($148 versus $205; $225 versus
$504). All-cause medical and pharmacy costs were also higher
among patients with comorbid diabetes. CONCLUSIONS:
Comorbid diabetes appears to substantially increase the cost of
providing both general medical care and bipolar-related health
services. Several mechanisms could account for these differences,
including clinical course of bipolar disorder, patient motivation
for medical care, and physician practice patterns. Further explo-
ration into these mechanisms is warranted.
PMH33
DRUG TREATMENT PATTERNS OF BIPOLAR DISORDER AND
ASSOCIATED COSTS
Wu EQ1, Birnbaum HG1, Greenberg P1, Kessler R2, Huang Z1,
Victor T3, Parece A1
1Analysis Group / Economics, Boston, MA, USA; 2Harvard University,
Boston, MA, USA; 3AstraZeneca Pharmaceuticals LP, Wilmington, DE,
USA
OBJECTIVES: The purpose of this study is to proﬁle the drug
treatment patterns of bipolar patients and compare the costs
associated with patients in alternative treatment groups.
METHODS: The study sample was drawn from a de-identiﬁed
administrative claims database of approximately 1.8 million
beneﬁciaries from 1999 to 2002, and including medical, drug,
and disability claims. Patients aged 18 to 65 years who had at
least 2 bipolar diagnoses, or 1 bipolar diagnosis and 1 prescrip-
tion for a mood stabilizer, were included (N = 3499). Costs were
measured from an employer’s perspective. All costs were adjusted
to 2002 dollars using Consumer Price Indices. T-tests were con-
ducted to estimate statistical signiﬁcance. RESULTS: Forty-ﬁve
percent of patients in the sample received no speciﬁc drug treat-
ment for bipolar disorder in the ﬁrst 2 months following their
diagnose, but 62% of this “no-treatment” group received anti-
depressants. Fifty percent of the sample took mood stabilizers in
the ﬁrst 2 months. Conventional antipsychotics were rarely used,
whereas atypical antipsychotics were usually taken concomi-
tantly with mood stabilizers. After the ﬁrst observed bipolar
episode, patients on mood stabilizer monotherapy incurred
increases in medical costs (36%) and drug costs (59%), and a
slight decrease in work-loss costs (-4.8%); patients on atypical
antipsychotics had a decrease in medical costs (16.8%), an
increase in drug costs (66%), and a decrease in work-loss costs
(13%). On average, therapy with atypical antipsychotics could
have saved $4796 annually, reﬂecting $4640 less in medical ser-
vices, $158 more in drug costs, and $314 less in indirect work-
loss costs compared with mood stabilizer monotherapy.
CONCLUSIONS: Bipolar patients were largely untreated or
treated inappropriately (with antidepressant monotherapy).
Appropriate combination therapy with atypical antipsychotics
and a mood stabilizer may reduce both direct health care costs
and indirect work-loss costs.
PMH34
COST-EFFECTIVENESS OF OLANZAPINE VERSUS LITHIUM
FOR THE PREVENTION OF RELAPSE IN BIPOLAR I DISORDER
IN AUSTRALIA
Price N1, Davey P1, Mudge M1, Fitzgerald B2, Rajan N2,
Montgomery B2
1M-TAG Pty Ltd, Chatswood, NSW, Australia; 2Eli Lilly Australia Pty
Ltd, West Ryde, NSW, Australia
OBJECTIVES: To assess the cost-effectiveness of olanzapine
compared with lithium in relapse prevention of bipolar I disor-
der. METHODS: Resource use data from a 52-week double-
blind randomised controlled trial of olanzapine versus lithium 
(n = 431) were used to determine costs of both treatments.
Resources considered were study drug, concomitant medication,


PMH33 DRUG TREATMENT PATTERNS OF BIPOLAR DISORDER AND ASSOCIATED COSTS 

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PMH33 DRUG TREATMENT PATTERNS OF BIPOLAR DISORDER AND ASSOCIATED COSTS

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