Background

Misdiagnosis of bipolar I disorder (BP-I) as major depressive disorder (MDD) is common. This study evaluated healthcare resource utilization (HRU) and costs among BP-I patients who were initially misdiagnosed with MDD (misdiagnosed BP-I cohort) versus patients diagnosed with BP-I without a known prior MDD diagnosis (BP-I only cohort).

Methods

Data from IBM® MarketScan® Research Databases were used. The index date was the first MDD diagnosis for misdiagnosed patients or first BP-I diagnosis for BP-I only patients. Inverse probability of treatment weighting was used to balance baseline characteristics between cohorts. All-cause and mental health (MH)-related HRU and costs were compared between weighted cohorts using rate ratios (RRs) and mean cost differences, respectively. Outcomes were reported per patient-year (PPY). Confidence intervals and P-values were calculated using non-parametric bootstrap procedures.

Results

Overall, 14,729 misdiagnosed BP-I and 16,072 BP-I only patients met criteria. Baseline characteristics were balanced across weighted cohorts. Misdiagnosed BP-I patients had significantly higher rates of hospitalizations, emergency room visits, and outpatient visits than BP-I only patients during follow-up (all-cause RRs: 1.94, 1.33, and 1.38, respectively, all P < .001; MH-related RRs: 2.19, 1.77, and 1.77, respectively, all P < .001). Similarly, misdiagnosed BP-I patients incurred significantly higher total healthcare costs PPY over follow-up (all-cause: $21,202 vs $14,661, cost difference = $6541; MH-related: $12,901 vs $6749, cost difference = $6152; both P < .001). Cost differences were even higher during the first year (all-cause = $7146; MH-related = $6619; both P < .001).

Limitations

Claims database (e.g., coding inaccuracies); generalizability to uninsured patients.

Conclusions

The prompt and correct diagnosis of BP-I may significantly reduce HRU and costs.

中文翻译：

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误诊双相 I 障碍的现实世界卫生资源使用和成本

背景

将双相 I 型障碍 (BP-I) 误诊为重度抑郁症 (MDD) 很常见。本研究评估了最初被误诊为 MDD 的 BP-I 患者（误诊 BP-I 队列）与没有已知先前 MDD 诊断的 BP-I 患者（仅 BP-I 队列）的医疗资源利用率 (HRU) 和成本。

方法

使用了来自 IBM® MarketScan® 研究数据库的数据。索引日期是误诊患者的首次 MDD 诊断或仅 BP-I 患者的首次 BP-I 诊断。治疗加权的逆概率用于平衡队列之间的基线特征。分别使用比率（RR）和平均成本差异在加权队列之间比较全因和心理健康（MH）相关的 HRU 和成本。每患者年 (PPY) 报告结果。使用非参数引导程序计算置信区间和P值。

结果

总体而言，14,729 名误诊 BP-I 和 16,072 名仅 BP-I 患者符合标准。基线特征在加权队列之间得到平衡。在随访期间，误诊 BP-I 患者的住院率、急诊就诊率和门诊就诊率显着高于仅 BP-I 患者（全因 RR 分别为 1.94、1.33 和 1.38，均P  < .001； MH 相关的 RR：分别为 2.19、1.77 和 1.77，所有P  < .001）。同样，误诊的 BP-I 患者的总医疗费用 PPY 显着高于随访（全因：21,202 美元对 14,661 美元，成本差异 = 6541 美元；MH 相关：12,901 美元对 6749 美元，成本差异 = 6152 美元；P < .001)。第一年的成本差异甚至更高（全因 = 7146 美元；MH 相关 = 6619 美元；P  < .001）。

限制

索赔数据库（例如，编码不准确）；对无保险患者的普遍性。

结论

BP-I 的及时和正确诊断可以显着降低 HRU 和成本。