Acute inpatient treatment, hospitalization course and direct costs in bipolar patients with intellectual disability.
To explore the impacts of intellectual disability (ID) on psychotropic medication use, length of hospital stay (LOS) and direct hospitalization costs during inpatient treatment for acute bipolar episodes, all 17,899 index hospitalizations due to acute bipolar episodes between 1998 and 2007 in Taiwan were identified from a total population health insurance claims database, amongst which 544 subjects had a concomitant diagnosis of ID. Pattern of psychotropic medication use, LOS, discharge outcome and direct costs during hospitalization were compared between bipolar patients with ID and without ID and multivariate models controlling for major cost confounders were used to explore the impacts of ID on LOS, discharge outcome and inpatient costs. The results indicated that, compared to bipolar patients without ID, bipolar patients with ID were younger, had longer LOS and received significantly lower daily equivalent dosages of antipsychotics, mood stabilizers, lithium and benzodiazepines. Significantly more bipolar patients with ID could not be discharged successfully. The longer LOS possibly reflected slower clinical stabilization, conservative use of medications and difficulty in community placement. The lower average daily reimbursements indicated that treatment of bipolar patients with ID were under-funded, whereas the higher total direct costs resulting from prolonged LOS placed greater economic straint on healthcare system. The findings support that bipolar patients with ID are clinically unique but relatively under-supported during acute hospitalization. Modifying current pharmacological intervention, health care resources allocation and community supporting structure is paramount to reducing LOS and improving hospitalization outcome.
Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
Chi-Shin
CS
Wu
Pushpal
P
Desarkar
Anna
A
Palucka
Yona
Y
Lunsky
Shi-Kai
SK
Liu
D000208:Acute Disease; D000328:Adult; D000368:Aged; D018692:Antimanic Agents / Q000191:economics / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000191:economics / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000191:economics / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000191:economics / Q000523:psychology / Q000628:therapy*; D016022:Case-Control Studies; D016527:Drug Costs; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008607:Intellectual Disability / Q000191:economics / Q000523:psychology / Q000628:therapy*; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D018020:Lithium Compounds / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D013624:Taiwan; D055815:Young Adult
D018692:Antimanic Agents; D014150:Antipsychotic Agents; D018020:Lithium Compounds; D001569:Benzodiazepines
Bipolar disorder (BD); Hospitalization costs; Intellectual disability (ID); Length of stay; Psychotropic medication