title: Characteristics, healthcare utilization and costs of bipolar disorder type I patients with and without frequent psychiatric intervention in a Medicaid population.
abstract: OBJECTIVE
  To compare characteristics, healthcare resource utilization and costs of Medicaid bipolar disorder (BPD) type I (BP-I) patients with and without frequent psychiatric intervention (FPI).
  
  
  METHODS
  Adults with BP-I, ≥ 1 prescription claim for a mood stabilizer/atypical antipsychotic and 24 months' continuous medical/prescription coverage were identified (MarketScan* Medicaid database). Patients with ≥ 2 clinically significant events (CSEs) during a 12-month identification period had FPI. CSEs included emergency department (ED) visits or hospitalizations with a principal diagnosis of BPD, addition of a new medication to the first observed treatment regimen or ≥ 50% increase in BPD medication dose. Demographic and clinical characteristics were evaluated for the identification period, and healthcare utilization and costs for the 12-month follow-up. Multivariate generalized linear modeling and multivariate logistic regression, respectively, were used to evaluate the impact of FPI on all-cause and psychiatric-related costs and risk of psychiatric-related hospitalization and ED visit during follow-up.
  
  
  RESULTS
  Of 5,527 BP-I patients, 53% had FPI. Relative to patients without FPI, those with FPI were younger and more likely to be female, had higher adjusted all-cause (+US$3,232, p < 0.001) and psychiatric-related (+US$2,519, p < 0.001) costs and higher risk of hospitalization (adjusted odds ratio [OR] = 3.681, 95% confidence interval [CI] = 2.85-4.75) and ED visit (OR = 3.094, 95% CI = 2.55-3.76).
  
  
  CONCLUSIONS
  Analysis used a convenience sample of Medicaid enrollees in several geographically dispersed states, limiting generalizability. Analyses of administrative claims data depend on accurate diagnoses and data entry.
  
  
  CONCLUSIONS
  BP-I patients with FPI incurred significantly higher healthcare resource utilization and costs during the follow-up period than those without FPI.
authors.affiliation: Thomson Reuters, Washington, DC, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Durden
authors.forename: Erin
authors.initials: E
authors.lastname: Bagalman
authors.forename: Erik
authors.initials: E
authors.lastname: Muser
authors.forename: Jiyoon C
authors.initials: JC
authors.lastname: Choi
authors.forename: Concetta
authors.initials: C
authors.lastname: Crivera
authors.forename: Riad
authors.initials: R
authors.lastname: Dirani
authors.forename: Wayne
authors.initials: W
authors.lastname: Macfadden
authors.forename: J Thomas
authors.initials: JT
authors.lastname: Haskins
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001714:Bipolar Disorder / Q000145:classification / Q000191:economics* / Q000628:therapy; D015331:Cohort Studies; D015897:Comorbidity; D004636:Emergency Service, Hospital / Q000191:economics; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008484:Medicaid / Q000706:statistics & numerical data*; D008605:Mental Health Services / Q000191:economics / Q000706:statistics & numerical data; D018803:Models, Economic; D012111:Residence Characteristics; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States; D055815:Young Adult