Online ISSN: 1099-176X Print
Copyright © 2010 ICMPE.
Costs Associated with Attempted Suicide among Individuals with Bipolar Disorder
Michael D. Stensland,1 Baojin Zhu,2 Haya Ascher-Svanum,*3 Daniel E. Ball4
1Ph.D., Agile Outcomes Research
Inc., Rochester, MN, USA.
Correspondence to: Haya Ascher-Svanum, Ph.D., Eli Lilly and Company, Lilly Corporate Center DC 4133, Indianapolis, IN 46285, USA.
Tel.: +1-317-277 8713
Fax: +1-317-276 7100
Source of Funding: Funding for this project was directly provided by Eli Lilly and Company. Baojin Zhu, Haya Ascher-Svanum, and Daniel Ball are all full-time employees of Eli Lilly and Company and minor shareholders. Michael Stensland was an employee of Eli Lilly and Company at the time this was written.
Background: Bipolar disorder is a chronic mood disorder associated with a high risk for suicide attempts, which carry personal, societal, and economical consequences. No information is available on the economic costs associated with suicide attempts among patients with bipolar disorder or the change in economic costs from before to following the suicide attempt.
Aims of the Study: The primary objective of this study was to estimate the total health care costs and cost components (inpatient, outpatient, emergency services, and medication) incurred by patients diagnosed with bipolar disorder who attempt suicide. Cost data included psychiatric and non-psychiatric costs. A secondary objective was to compare patients with and without attempted suicide on demographic and clinical characteristics.
Methods: Data for this retrospective study were obtained from the PharMetrics1 Integrated Outcomes Database (1995-2005). Patients diagnosed with bipolar disorder with (N=352) and without (N=15,102) a suicide attempt were identified and compared on demographics and psychiatric and medical comorbidities. T-tests and chi-square tests were used for group comparisons of patient characteristics. Among patients who attempted suicide and were continuously enrolled in the year before and following the suicide attempt (N=352), Wilcoxon signed-rank tests were used to compare health care costs between the year prior and the year following the first suicide attempt.
Results: The average total health care cost for the year following the suicide attempt (N=352) was $25,012, which was more than 2 times higher than the $11,476 incurred in the prior 1-year period (p.<001). The total health care cost in the first month following the suicide attempt accounted for 28.9% of the total annual cost. The cost distribution over time showed a large spike for inpatient and emergency services costs in the month following the attempt with sustained increases in medication and outpatient costs. Patients with suicide attempt (N=1,147) were significantly more likely than patients without (N=15,102) to be younger, female, and to have comorbid psychiatric and medical diagnoses, especially depressive and substance use disorders.
Discussion: The substantial economic costs incurred by patients with bipolar disorder who attempt suicide are marked by an increase in costs of crisis services during the first month following the suicide attempt, along with sustained increases in medication and outpatient costs during the year following the suicide attempt. Limitations of the study include reliance on claims data and potential lack of generalizability beyond private payer data.
Implications for Health Care Provision and Use: Interventions designed to reduce the risk of suicide attempts among patients diagnosed with bipolar disorder may help decrease the related high economic costs, in addition to helping decrease adverse personal and societal consequences.
Implications for Health Policies: Cost-benefit analyses of treatment methods for bipolar disorder need to include the considerable expenses associated with suicide attempts. Current findings may also be of value for modeling the cost-effectiveness of treatment for bipolar disorder and of interest to payers and other health care decision makers, especially those involved in developing Medicare capitation models for patients with chronic conditions such as bipolar disorder.
Implications for Further Research: Additional research is needed on the cost of attempted suicide in the treatment of patients with bipolar disorder, especially studies that capture societal costs.
7 December 2009; accepted 26 March 2010
Copyright © 2010 ICMPE