New data presented at the National Institute of Mental Health's 44th Annual New Clinical Drug Evaluation Unit (NCDEU) meeting revealed that as many as 45 per cent of bipolar patients received no specific drug treatment for bipolar disorder in the first two months following a bipolar diagnosis. In addition, 62 per cent of this 'no-treatment' group received antidepressants, which are contraindicated with bipolar disorder treatment guidelines.

Further analysis presented last month at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 9th annual meeting in Arlington, showed that compared with use of mood stabilizer monotherapy, use of newer types of drugs known as atypical antipsychotics was associated with savings of approximately $4,800 annually in 2002 dollars ($4,640 savings in medical service costs and $314 savings in indirect workplace costs, with $158 increase in drug costs).

The study also showed that medical resources used by bipolar patients totaled about $5,300 more annually compared with individuals who did not suffer from this mental illness. In addition, workers with bipolar disorder cost almost $1,800 more annually to their employers in terms of disability payments and sporadic absenteeism due to their medical condition. Taken together, these results demonstrate that the economic burden of bipolar disorder exceeds that of major depression at the patient level.

"These findings clearly show the complex and costly nature of bipolar disorder, and make the business case for more proactive and intensive treatment," said Paul Greenberg of Analysis Group, the economics consulting firm that conducted the study. "Specifically, the increase in pharmacy costs seen with the addition of atypical antipsychotics represented a fraction of the potential savings we saw in medical and indirect costs when these drugs are used appropriately."

The study also looked at comorbidities that may help explain the high costs of bipolar disorder, and the potential for savings with more aggressive treatment. Patients with bipolar disorder had significantly higher risks of substance abuse, psychotic disorders, anxiety disorder, eating and sleeping disorders, suicide or self-harm, and accidental injuries when compared to individuals without bipolar disorder.

"The destructive and costly nature of bipolar disorder becomes readily apparent from this examination of comorbid conditions, related healthcare utilization and work loss," said Tim Victor of AstraZeneca Pharmaceuticals, provider of grant funding for the study. "The considerable reduction in associated medical and work loss costs among those patients who received atypical antipsychotics points to the significant benefits of providing proper treatment for these patients," he added.