The real world cost and health resource utilization associated to manic episodes: The MANACOR study.
BACKGROUND
Bipolar disorder is a relapsing-remitting condition affecting approximately 1-2% of the population. Even when the treatments available are effective, relapses are still very frequent. Therefore, the burden and cost associated to every new episode of the disorder have relevant implications in public health. The main objective of this study was to estimate the associated health resource consumption and direct costs of manic episodes in a real world clinical setting, taking into consideration clinical variables.


METHODS
Bipolar I disorder patients who recently presented an acute manic episode based on DSM-IV criteria were consecutively included. Sociodemographic variables were retrospectively collected and during the 6 following months clinical variables were prospectively assessed (YMRS,HDRS-17,FAST and CGI-BP-M). The health resource consumption and associate cost were estimated based on hospitalization days, pharmacological treatment, emergency department and outpatient consultations.


RESULTS
One hundred sixty-nine patients patients from 4 different university hospitals in Catalonia (Spain) were included. The mean direct cost of the manic episodes was €4,771. The 77% (€3,651) was attributable to hospitalization costs while 14% (€684) was related to pharmacological treatment, 8% (€386) to outpatient visits and only 1% (€50) to emergency room visits. The hospitalization days were the main cost driver. An initial FAST score>41 significantly predicted a higher direct cost.


CONCLUSIONS
Our results show the high cost and burden associated with BD and the need to design more cost-efficient strategies in the prevention and management of manic relapses in order to avoid hospital admissions. Poor baseline functioning predicted high costs, indicating the importance of functional assessment in bipolar disorder.
Programa de Trastornos Bipolares, Instituto de Neurociencias, Hospital Clínic de Barcelona, IDIBAPS, CIBERSAM, Universidad de Barcelona, Barcelona, Cataluña, España.
Diego
D
Hidalgo-Mazzei
Programa de Trastornos Bipolares, Instituto de Neurociencias, Hospital Clínic de Barcelona, IDIBAPS, CIBERSAM, Universidad de Barcelona, Barcelona, Cataluña, España; Departamento de Psiquiatría, Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile.
Juan
J
Undurraga
Programa de Trastornos Bipolares, Instituto de Neurociencias, Hospital Clínic de Barcelona, IDIBAPS, CIBERSAM, Universidad de Barcelona, Barcelona, Cataluña, España.
María
M
Reinares
Programa de Trastornos Bipolares, Instituto de Neurociencias, Hospital Clínic de Barcelona, IDIBAPS, CIBERSAM, Universidad de Barcelona, Barcelona, Cataluña, España.
Caterina del Mar
Cdel M
Bonnín
Hospital Psiquiátrico Universitario, Instituto Pere Mata, CIBERSAM, Reus, Cataluña, España.
Cristina
C
Sáez
Servicio de Salud Mental, Hospital Santa María, Instituto de Investigación Biomédica (IRB) Lleida, Universidad de Lleida, Lleida, Cataluña, España.
María
M
Mur
Althaia, Red Asistencial Universitaria de Manresa, Manresa, Catalonia, España.
Evaristo
E
Nieto
Programa de Trastornos Bipolares, Instituto de Neurociencias, Hospital Clínic de Barcelona, IDIBAPS, CIBERSAM, Universidad de Barcelona, Barcelona, Cataluña, España. Electronic address: evieta@clinic.ub.es.
Eduard
E
Vieta
D000208:Acute Disease; D000328:Adult; D018692:Antimanic Agents / Q000191:economics / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000191:economics* / Q000628:therapy*; D004565:Electroconvulsive Therapy / Q000191:economics / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006785:Hospitals, University / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D013030:Spain
D018692:Antimanic Agents
Bipolar disorder; Burden; Carga; Cost; Coste; Mania; Manía; Trastorno bipolar