Abstract
To evaluate and compare healthcare resource utilization (HCRU) and costs between bipolar I disorder (BD-I) patients diagnosed with and without comorbid substance abuse (SA). Using the Truven Health Analytics MarketScan® Medicaid, Commercial, and Medicare Supplemental databases (7/1/15-6/30/16-Medicaid, 7/1/15-3/31/16-Commercial and Medicare Supplemental), adult patients ≥18 years with BD-I were identified if they initiated an atypical oral antipsychotic treatment and had ≥6-month continuous enrollment before (baseline) and after (follow-up) the first day of treatment (the index date). Presence of comorbid SA was determined based upon having ≥1 claim with a relevant ICD-9/10 or procedure code in baseline. Multivariable regression models were conducted to estimate adjusted utilization and costs, controlling for demographic and clinical characteristics, insurance type, baseline medication, and baseline hospitalization. Of 18,388 identified patients with BD-I who initiated atypical antipsychotics, 4,307 (23.4%) had comorbid SA; the remaining 14,081 (76.6%) were without SA. At baseline, patients with SA were younger [mean (SD) 38.0 (13.3) years vs. 41.0 (14.8) years], had a higher general disease burden measured by mean (SD) Charlson Comorbidity Index [0.9 (1.6) vs. 0.7 (1.4)], and higher hospitalization rate (55.1% vs. 19.4%) (p<0.001) than those without SA. Controlling for baseline differences, patients with SA had statistically significantly higher adjusted all-cause and psychiatric-specific hospitalization rates [17.8% vs. 13.0% (all-cause); 10.6% vs. 7.0% (psychiatric)] and medical costs [$11,142 vs. $9,332 (all-cause); $5,369 vs. $3,271 (psychiatric)] during the follow-up period (p<0.001). BD-I patients with comorbid SA had higher all-cause and psychiatric-specific hospitalization rates and costs. Efforts to address comorbid SA in BD-I patients may help reduce HCRU and costs.
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