The societal cost of bipolar disorder in Sweden

• Published in: Social Psychiatry and Psychiatric Epidemiology Vol. 48; no. 10; pp. 1601 - 1610
• Main Authors: Ekman, Mattias, Granström, Ola, Omérov, Sead, Jacob, Johanna, Landén, Mikael
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-10-2013; Springer; Springer Nature B.V
• Subjects: Adult; Adult and adolescent clinical studies; Ambulatory Care - economics; Biological and medical sciences; Bipolar affective disorder; Bipolar disorder; Bipolar Disorder - economics; Bipolar Disorder - epidemiology; Bipolar Disorder - psychology; Bipolar Disorder - therapy; Bipolar disorders; Burden-of-illness; Clinical Medicine; Cost; Cost estimates; Cost of Illness; Direct Service Costs - statistics & numerical data; DOUBLE-BLIND; Early retirement; Economic aspects; Economics; Epidemiology; Female; Health Care Costs; Hospitalization; Hospitalization - economics; Human capital; Humans; Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi; Hälsovetenskap; Illnesses; International Classification of Diseases; ISSUES; Klinisk medicin; Male; MANIC EPISODES; Medical research; Medical sciences; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Medicine, Experimental; Mental Health Services - economics; Middle Aged; Miscellaneous; Mood disorders; Neurosciences; OF-ILLNESS; OLANZAPINE; Original Paper; Patients; Pharmaceuticals; PREVALENCE; Productivity; Psychiatric services; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psykiatri; QUETIAPINE; Remission (Medicine); Resource use; Retrospective Studies; Severity of Illness Index; Sick leave; Sick Leave - economics; Sick Leave - statistics & numerical data; Social aspects; Socioeconomic Factors; Sweden - epidemiology; Sweden; Europe; United States > US; Sweden, Stockholm; Economics; Bipolar affective disorder; Burden-of-illness; Cost; Resource use; Human; Affective disorder; Mood disorder; Mental health; Bipolar disorder; Public health
• ISSN: 0933-7954; 1433-9285; 1433-9285
• DOI: 10.1007/s00127-013-0724-9

Purpose
There is a lack of comprehensive cost-of-illness studies in bipolar disorder, in particular studies based on patient-level data. The purpose of this study was to estimate the societal cost of bipolar disorder and to relate costs to disease severity, depressive episodes, hospitalisation and patient functioning.
Methods
Retrospective resource use data in inpatient and outpatient care during 2006–2008, as well as ICD-10 diagnoses and Global Assessment of Functioning (GAF) scores, were obtained from the Northern Stockholm psychiatric clinic with a catchment area including 47 % of the adult inhabitants in Stockholm. This dataset was combined with national register data on prescription pharmaceuticals and sick leave to estimate the societal cost of bipolar disorder. The study was conducted from a societal perspective, with indirect costs valued according to the human capital method.
Results
The average annual cost per patient was €28,011 in 2008 (
n
 = 1,846). Indirect costs due to sick leave and early retirement represented 75 %, inpatient costs 13 %, outpatient costs 8 %, pharmaceuticals 2 % and community care another 2 % of the total cost. Total costs were considerably higher during mood episodes (six times higher than in remission), for hospitalised patients (€55,500 vs. €22,200) and for patients with low GAF scores.
Conclusions
The high cost of bipolar disorder is driven primarily by indirect costs. Costs were strongly associated with mood episodes, hospitalisations and low GAF scores. This suggests that treatment that reduces the risk for relapses and hospitalizations and improve functioning may decrease both the societal cost of bipolar disorder and patient suffering.