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Opioids & SU

The Literature Collection contains over 7,000 references for published and grey literature on the integration of behavioral health and primary care. Learn More

Use the Search feature below to find references for your terms across the entire Literature Collection, or limit your searches by Authors, Keywords, or Titles and by Year, Type, or Topic. View your search results as displayed, or use the options to: Show more references per page; Sort references by Title or Date; and Refine your search criteria. Expand an individual reference to View Details. Full-text access to the literature may be available through a link to PubMed, a DOI, or a URL. References may also be exported for use in bibliographic software (e.g., EndNote, RefWorks, Zotero).

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913 Results
1
"Big Eight" Recommendations for Improving the Effectiveness of the U.S. Behavioral Health Care System
Type: Journal Article
Authors: M. Karakus, S. S. Ghose, H. H. Goldman, G. Moran, M. F. Hogan
Year: 2017
Source:
Karakus M, Ghose SS, Goldman HH, Moran G, Hogan MF. "Big Eight" Recommendations for Improving the Effectiveness of the U.S. Behavioral Health Care System. Psychiatric Services (Washington, D.c.) 2017;68. https://doi.org/10.1176/appi.ps.201500532.
Publication Place: United States
Abstract: The purpose of this Open Forum is to highlight strategies that can be implemented by federal health care policy makers to improve the delivery of effective behavioral health care services in the public and private sectors. The recommendations can be accomplished by using existing funds or authorities allocated to federal agencies dealing with the behavioral health system. These recommendations do not require new or additional funding and focus on strategies with a track record for success. The strategies described require relatively small changes but have the potential for big impacts.
Topic(s):
Financing & Sustainability See topic collection
,
Healthcare Policy See topic collection
2
"Cost-effectiveness of cognitive-behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care: economic evaluation of the CoBalT Trial": Correction.
Type: Journal Article
Authors: Sandra Hollinghurst, Fran E. Carroll, Anna Abel, John Campbell, Anne Garland, Bill Jerrom, David Kessler, Willem Kuyken, Jill Morrison, Nicola Ridgway, Laura Thomas, Katrina Turner, Chris Williams, Tim J. Peters, Nicola Wiles, Glyn Lewis
Year: 2014
Source:
Hollinghurst S, Carroll FE, Abel A, Campbell J, Garland A, Jerrom B, et al. "Cost-effectiveness of cognitive-behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care: economic evaluation of the CoBalT Trial": Correction. The British Journal Of Psychiatry 2014;204.
Topic(s):
Financing & Sustainability See topic collection
3
$75 annual limit for CM hampers stimulant addiction treatment
Type: Journal Article
Authors: Alison Knopf
Year: 2020
Source:
Knopf A. $75 annual limit for CM hampers stimulant addiction treatment. Brown University Child & Adolescent Psychopharmacology Update 2020;22:1-5, . https://doi.org/10.1002/cpu.30526.
Publication Place: Hoboken, New Jersey
Topic(s):
Financing & Sustainability See topic collection
,
Opioids & Substance Use See topic collection
4
'Communities are attempting to tackle the crisis': a scoping review on community plans to prevent and reduce opioid-related harms
Type: Journal Article
Authors: P. Leece, T. Khorasheh, N. Paul, S. Keller-Olaman, S. Massarella, J. Caldwell, M. Parkinson, C. Strike, S. Taha, G. Penney, R. Henderson, H. Manson
Year: 2019
Source:
Leece P, Khorasheh T, Paul N, Keller-Olaman S, Massarella S, Caldwell J, et al. 'Communities are attempting to tackle the crisis': a scoping review on community plans to prevent and reduce opioid-related harms. Bmj Open 2019;9:2018-028583, e028583+. https://doi.org/10.1136/bmjopen-2018-028583.
Topic(s):
Education & Workforce See topic collection
,
Financing & Sustainability See topic collection
,
Healthcare Disparities See topic collection
,
Opioids & Substance Use See topic collection
5
A blueprint for integrated mental health care: Commentary for "Costs of using evidence-based implementation strategies for behavioral health integration in a large primary care system"
Type: Journal Article
Authors: T. E. Chang, T. G. Ferris
Year: 2020
Source:
Chang TE, Ferris TG. A blueprint for integrated mental health care: Commentary for "Costs of using evidence-based implementation strategies for behavioral health integration in a large primary care system". Health Services Research 2020;55:911-912, . https://doi.org/10.1111/1475-6773.13593.
Topic(s):
Financing & Sustainability See topic collection
,
Healthcare Disparities See topic collection
6
A budget impact analysis of telemedicine-based collaborative care for depression
Type: Journal Article
Authors: J. C. Fortney, M. L. Maciejewski, S. P. Tripathi, T. L. Deen, J. M. Pyne
Year: 2011
Source:
Fortney JC, Maciejewski ML, Tripathi SP, Deen TL, Pyne JM. A budget impact analysis of telemedicine-based collaborative care for depression. Medical Care 2011;49:872-880, . https://doi.org/10.1097/MLR.0b013e31821d2b35.
Publication Place: United States
Abstract: BACKGROUND: Patients with depression use more health services than patients without depression. However, when depression symptoms respond to treatment, use of health services declines. Most depression quality improvement studies increase total cost in the short run, which if unevenly distributed across stakeholders, could compromise buy-in and sustainability. The objective of this budget impact analysis was to examine patterns of utilization and cost associated with telemedicine-based collaborative care, an intervention that targets patients treated in small rural primary care clinics. METHODS: Patients with depression were recruited from VA Community-based Outpatient Clinics, and 395 patients were enrolled and randomized to telemedicine-based collaborative care or usual care. Dependent variables representing utilization and cost were collected from administrative data. Independent variables representing clinical casemix were collected from self-report at baseline. RESULTS: There were no significant group differences in the total number or cost of primary care encounters. However, as intended, patients in the intervention group had significantly greater depression-related primary care encounters (marginal effect=0.34, P=0.004) and cost (marginal effect=$61.4, P=0.013) to adjust antidepressant therapy for nonresponders. There were no significant group differences in total mental health encounters or cost. However, as intended, the intervention group had significantly higher depression-related mental health costs (marginal effect=$107.55, P=0.03) due to referrals of treatment-resistant patients. Unexpectedly, patients in the intervention group had significantly greater specialty physical health encounters (marginal effect =0.42, P=0.001) and cost (marginal effect =$490.6, P=0.003), but not depression-related encounters or cost. Overall, intervention patients had a significantly greater total outpatient cost compared with usual care (marginal effect=$599.28, P=0.012). CONCLUSIONS: Results suggest that telemedicine-based collaborative care does not increase total workload for primary care or mental health providers. Thus, there is no disincentive for mental health providers to offer telemedicine-based collaborative care or for primary care providers to refer patients to telemedicine-based collaborative care.
Topic(s):
Financing & Sustainability See topic collection
7
A Budget Impact Analysis of the Collaborative Care Model for Treating Opioid Use Disorder in Primary Care
Type: Journal Article
Authors: C. M. Lee, C. Scheuter, D. Rochlin, T. Platchek, R. M. Kaplan
Year: 2019
Source:
Lee CM, Scheuter C, Rochlin D, Platchek T, Kaplan RM. A Budget Impact Analysis of the Collaborative Care Model for Treating Opioid Use Disorder in Primary Care. Journal Of General Internal Medicine 2019;34:1693-1694, . https://doi.org/10.1007/s11606-019-04998-5.
Topic(s):
Education & Workforce See topic collection
,
Financing & Sustainability See topic collection
,
Opioids & Substance Use See topic collection
8
A Case Study of Implementing Grant-Funded Integrated Care in a Community Mental Health Center
Type: Journal Article
Authors: M. Aby
Year: 2020
Source:
Aby M. A Case Study of Implementing Grant-Funded Integrated Care in a Community Mental Health Center. The Journal Of Behavioral Health Services & Research 2020;47:293-308, . https://doi.org/10.1007/s11414-019-09671-7.
Abstract:

The US government funds integrated care demonstration projects to decrease health disparities for individuals with serious mental illness. Drawing on the Exploration Preparation Implementation Sustainability (EPIS) implementation framework, this case study of a community mental health clinic describes implementation barriers and sustainability challenges with grant-funded integrated care. Findings demonstrate that integrated care practices evolve during implementation and the following factors influenced sustainability: workforce rigidity, intervention clarity, policy and funding congruence between the agency and state/federal regulations, on-going support and training in practice application, and professional institutions. Implementation strategies for primary care integration within CMHCs include creating a flexible workforce, shared definition of integrated care, policy and funding congruence, and on-going support and training.

Topic(s):
Education & Workforce See topic collection
,
Financing & Sustainability See topic collection
,
Healthcare Disparities See topic collection
9
A Case Study of Implementing Grant-Funded Integrated Care in a Community Mental Health Center
Type: Journal Article
Authors: Aby Martha
Year: 2020
Source:
Martha A. A Case Study of Implementing Grant-Funded Integrated Care in a Community Mental Health Center. The Journal Of Behavioral Health Services & Research 2020;47:293-308, . https://doi.org/10.1007/s11414-019-09671-7.
Publication Place: New York
Topic(s):
Education & Workforce See topic collection
,
Financing & Sustainability See topic collection
,
Healthcare Disparities See topic collection
10
A collaborative approach for the care management of geropsychiatric services
Type: Journal Article
Authors: E. Aliberti, C. Basso, E. Schramm
Year: 2011
Source:
Aliberti E, Basso C, Schramm E. A collaborative approach for the care management of geropsychiatric services. Professional Case Management 2011;16:62-68; quiz 69-70, . https://doi.org/10.1097/NCM.0b013e318206a27b.
Publication Place: United States
Abstract: PURPOSE/OBJECTIVES: To share a successful collaborative approach between the medical and behavioral health departments of a managed care organization that improved both utilization rates and management for health plan members with dementia. PRIMARY PRACTICE SETTING: Acute care hospitals FINDINGS/CONCLUSIONS: There was a significant reduction in subsequent hospital admits, beddays, and emergency department visits for this population resulting in a substantial financial savings. Patient outcomes, as well as patient and caregiver satisfaction, was improved. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Prior to the implementation of this pilot, there was a gap in services for health plan members experiencing dangerous behavioral issues associated with their dementia diagnosis. Case management of this population was difficult because of the limited options available in our market area. This innovative program afforded a nontraditional approach to inpatient care that maximized case management possibilities for this population.
Topic(s):
Financing & Sustainability See topic collection
11
A comparison of adherence, outcomes, and costs among opioid use disorder Medicaid patients treated with buprenorphine and methadone: A view from the payer perspective
Type: Journal Article
Authors: Suzanne Kinsky, Patricia R. Houck, Kristin Mayes, David Loveland, Dennis Daley, James M. Schuster
Year: 2019
Source:
Kinsky S, Houck PR, Mayes K, Loveland D, Daley D, Schuster JM. A comparison of adherence, outcomes, and costs among opioid use disorder Medicaid patients treated with buprenorphine and methadone: A view from the payer perspective. Journal Of Substance Abuse Treatment 2019;104:15-21, . https://doi.org/10.1016/j.jsat.2019.05.015.
Topic(s):
Financing & Sustainability See topic collection
,
Healthcare Disparities See topic collection
,
Opioids & Substance Use See topic collection
12
A comparison of buprenorphine and psychosocial treatment outcomes in psychosocial and medical settings
Type: Journal Article
Authors: N. J. Presnall, D. A. P. S. Wolf, D. S. Brown, S. Beeler-Stinn, R. A. Grucza
Year: 2019
Source:
Presnall NJ, Wolf DAPS, Brown DS, Beeler-Stinn S, Grucza RA. A comparison of buprenorphine and psychosocial treatment outcomes in psychosocial and medical settings. Journal Of Substance Abuse Treatment 2019;104:135-143, . https://doi.org/10.1016/j.jsat.2019.06.010.
Topic(s):
Education & Workforce See topic collection
,
Financing & Sustainability See topic collection
,
Opioids & Substance Use See topic collection
13
A Comparison Study of Primary Care Utilization and Mental Health Disorder Diagnoses Among Children In and Out of Foster Care on Medicaid
Type: Journal Article
Authors: R. J. Keefe, B. S. Van Horne, C. M. Cain, K. Budolfson, R. Thompson, C. S. Greeley
Year: 2020
Source:
Keefe RJ, Van Horne BS, Cain CM, Budolfson K, Thompson R, Greeley CS. A Comparison Study of Primary Care Utilization and Mental Health Disorder Diagnoses Among Children In and Out of Foster Care on Medicaid. Clinical Pediatrics 2020;59:252-258, . https://doi.org/10.1177/0009922819898182.
Publication Place: United States
Abstract:

The purpose of this study was to compare the utilization of primary care services and presence of mental health disorder diagnoses among children in foster care to children on Medicaid not in foster care in a large health system. The data for this study were analyzed from a clinical database of a multipractice pediatric health system in Houston, Texas. The sample included more than 95 000 children covered by Medicaid who had at least one primary care visit during the 2-year study period. The results of the study demonstrated that children not in foster care had a greater number of primary care visits and the odds of having >3 visits were significantly lower for children in foster care with a mental health disorder diagnosis. Additionally, more than a quarter of children in foster care had a diagnosis of a mental health disorder, compared with 15% of children not in foster care.

Topic(s):
Financing & Sustainability See topic collection
,
Healthcare Disparities See topic collection
14
A Cost Analysis of a Stepped Care Treatment Approach for Anxiety Disorders in Youth
Type: Journal Article
Authors: C. E. Yeguez, T. F. Page, Y. Rey, W. K. Silverman, J. W. Pettit
Year: 2020
Source:
Yeguez CE, Page TF, Rey Y, Silverman WK, Pettit JW. A Cost Analysis of a Stepped Care Treatment Approach for Anxiety Disorders in Youth. Journal Of Clinical Child And Adolescent Psychology : The Official Journal For The Society Of Clinical Child And Adolescent Psychology, American Psychological Association, Division 53 2020;49:549-555, . https://doi.org/10.1080/15374416.2018.1539913.
Abstract:

To address the high demand for youth anxiety treatment, researchers have begun to evaluate stepped care approaches to use limited resources efficiently. Quantifying cost savings can inform policy decisions about optimal ways to use limited resources. This study presents a cost analysis of a stepped care treatment approach for anxiety disorders in youth. Youths (N = 112) completed an 8-session computer-administered attention bias modification treatment (Step 1), and families were given the option to "step up" to cognitive behavioral therapy (CBT; Step 2). Stepped care treatment cost estimates were based on (a) resources used in treatment (i.e., clinician/paraprofessional time, equipment/materials) and (b) Medicaid reimbursement rates for clinician and paraprofessional time. We compared these two cost estimates with a hypothetical standard treatment approach for youth anxiety disorders: CBT only. We also tested predictive models to determine whether they could guide decisions about which youths, based on baseline characteristics, should be assigned to stepped care or directly to CBT only to avoid the costs associated with Step 1. Compared to a hypothetical standard CBT approach, the stepped care treatment was associated with an overall cost savings of 44.4% for the Medicaid reimbursement model and 47.7% for the resource cost model. The predictive models indicated that assigning all youths to stepped care would be more cost-effective than assigning certain youths directly to CBT only. This study provides the first evidence that a stepped care treatment approach for youth anxiety is associated with substantial cost savings compared with a standard CBT.

Topic(s):
Financing & Sustainability See topic collection
,
Healthcare Disparities See topic collection
15
A Danish cost-effectiveness model of escitalopram in comparison with citalopram and venlafaxine as first-line treatments for major depressive disorder in primary care
Type: Journal Article
Authors: J. Sorensen, K. B. Stage, N. Damsbo, A. Le Lay, M. E. Hemels
Year: 2007
Source:
Sorensen J, Stage KB, Damsbo N, Le Lay A, Hemels ME. A Danish cost-effectiveness model of escitalopram in comparison with citalopram and venlafaxine as first-line treatments for major depressive disorder in primary care. Nordic Journal Of Psychiatry 2007;61:100-108, . https://doi.org/10.1080/08039480701226070.
Publication Place: Norway
Abstract: The objective of this study was to model the cost-effectiveness of escitalopram in comparison with generic citalopram and venlafaxine in primary care treatment of major depressive disorder (baseline scores 22-40 on the Montgomery-Asberg Depression Rating Scale, MADRS) in Denmark. A three-path decision analytic model with a 6-month horizon was used. All patients started at the primary care path and were referred to outpatient or inpatient secondary care in the case of insufficient response to treatment. Model inputs included drug-specific probabilities derived from systematic literature review, ad-hoc survey and expert opinion. Main outcome measures were remission defined as MADRS < or = 12 and treatment costs. Analyses were conducted from healthcare system and societal perspectives. The human capital approach was used to estimate societal cost of lost productivity. Costs were reported in 2004 DDK. The expected overall 6-month remission rate was higher for escitalopram (64.1%) than citalopram (58.9%). From both perspectives, the total expected cost per successfully treated patient was lower for escitalopram (DKK 22,323 healthcare, DKK 72,399 societal) than for citalopram (DKK 25,778 healthcare, DKK 87,786 societal). Remission rates and costs were similar for escitalopram and venlafaxine. Robustness of the findings was verified in multivariate sensitivity analyses. For patients in primary care, escitalopram appears to be a cost-effective alternative to (generic) citalopram, with greater clinical benefit and cost-savings, and similar in cost-effectiveness to venlafaxine.
Topic(s):
Financing & Sustainability See topic collection
16
A Difference-in-Difference Analysis of Changes in Quality, Utilization and Cost Following the Colorado Multi-Payer Patient-Centered Medical Home Pilot
Type: Journal Article
Authors: M. B. Rosenthal, S. Alidina, M. W. Friedberg, S. J. Singer, D. Eastman, Z. Li, E. C. Schneider
Year: 2016
Source:
Rosenthal MB, Alidina S, Friedberg MW, Singer SJ, Eastman D, Li Z, et al. A Difference-in-Difference Analysis of Changes in Quality, Utilization and Cost Following the Colorado Multi-Payer Patient-Centered Medical Home Pilot. Journal Of General Internal Medicine 2016;31:289-296, . https://doi.org/10.1007/s11606-015-3521-1.
Publication Place: United States
Abstract: BACKGROUND: Research on the effects of patient-centered medical homes on quality and cost of care is mixed, so further study is needed to understand how and in what contexts they are effective. OBJECTIVE: We aimed to evaluate effects of a multi-payer pilot promoting patient-centered medical home implementation in 15 small and medium-sized primary care groups in Colorado. DESIGN: We conducted difference-in-difference analyses, comparing changes in utilization, costs, and quality between patients attributed to pilot and non-pilot practices. PARTICIPANTS: Approximately 98,000 patients attributed to 15 pilot and 66 comparison practices 2 years before and 3 years after the pilot launch. MAIN MEASURES: Healthcare Effectiveness Data and Information Set (HEDIS) derived measures of diabetes care, cancer screening, utilization, and costs to payers. KEY RESULTS: At the end of two years, we found a statistically significant reduction in emergency department use by 1.4 visits per 1000 member months, or approximately 7.9 % (p = 0.02). At the end of three years, pilot practices sustained this difference with 1.6 fewer emergency department visits per 1000 member months, or a 9.3 % reduction from baseline (p = 0.01). Emergency department costs were lower in the pilot practices after two (13.9 % reduction, p < 0.001) and three years (11.8 % reduction, p = 0.001). After three years, compared to control practices, primary care visits in the pilot practices decreased significantly (1.5 % reduction, p = 0.02). The pilot was associated with increased cervical cancer screening after two (12.5 % increase, p < 0.001) and three years (9.0 % increase, p < 0.001), but lower rates of HbA1c testing in patients with diabetes (0.7 % reduction at three years, p = 0.03) and colon cancer screening (21.1 % and 18.1 % at two and three years, respectively, p < 0.001). For patients with two or more comorbidities, similar patterns of association were found, except that there was also a reduction in ambulatory care sensitive inpatient admissions (10.3 %; p = 0.05). CONCLUSION: Our findings suggest that a multi-payer, patient-centered medical home initiative that provides financial and technical support to participating practices can produce sustained reductions in utilization with mixed results on process measures of quality.
Topic(s):
Financing & Sustainability See topic collection
,
Medical Home See topic collection
17
A Financial Model for Team-Based Opioid Use Disorder Treatment
Type: Journal Article
Authors: M. Farrar, Z. White, S. Hulkower, E. B. Fagan, C. G. Wilson
Year: 2020
Source:
Farrar M, White Z, Hulkower S, Fagan EB, Wilson CG. A Financial Model for Team-Based Opioid Use Disorder Treatment. Journal Of The American Board Of Family Medicine : Jabfm 2020;33:124-128, . https://doi.org/10.3122/jabfm.2020.01.190228.
Publication Place: United States
Topic(s):
Education & Workforce See topic collection
,
Financing & Sustainability See topic collection
,
Opioids & Substance Use See topic collection
18
A mixed-method comparison of physician-reported beliefs about and barriers to treatment with medications for opioid use disorder
Type: Journal Article
Authors: R. L. Haffajee, B. Andraka-Christou, J. Attermann, A. Cupito, J. Buche, A. J. Beck
Year: 2020
Source:
Haffajee RL, Andraka-Christou B, Attermann J, Cupito A, Buche J, Beck AJ. A mixed-method comparison of physician-reported beliefs about and barriers to treatment with medications for opioid use disorder. Substance Abuse Treatment, Prevention, And Policy 2020;15:69+. https://doi.org/10.1186/s13011-020-00312-3.
Abstract:

BACKGROUND: Evidence demonstrates that medications for treating opioid use disorder (MOUD) -namely buprenorphine, methadone, and extended-release naltrexone-are effective at treating opioid use disorder (OUD) and reducing associated harms. However, MOUDs are heavily underutilized, largely due to the under-supply of providers trained and willing to prescribe the medications. METHODS: To understand comparative beliefs about MOUD and barriers to MOUD, we conducted a mixed-methods study that involved focus group interviews and an online survey disseminated to a random group of licensed U.S. physicians, which oversampled physicians with a preexisting waiver to prescribe buprenorphine. Focus group results were analyzed using thematic analysis. Survey results were analyzed using descriptive and inferential statistical methods. RESULTS: Study findings suggest that physicians have higher perceptions of efficacy for methadone and buprenorphine than for extended-release naltrexone, including for patients with co-occurring mental health disorders. Insurance obstacles, such as prior authorization requirements, were the most commonly cited barrier to prescribing buprenorphine and extended-release naltrexone. Regulatory barriers, such as the training required to obtain a federal waiver to prescribe buprenorphine, were not considered significant barriers by many physicians to prescribing buprenorphine and naltrexone in office-based settings. Nor did physicians perceive diversion to be a prominent barrier to prescribing buprenorphine. In focus groups, physicians identified financial, logistical, and workforce barriers-such as a lack of addiction treatment specialists-as additional barriers to prescribing medications to treat OUD. CONCLUSIONS: Additional education is needed for physicians regarding the comparative efficacy of different OUD medications. Governmental policies should mandate full insurance coverage of and prohibit prior authorization requirements for OUD medications.

Topic(s):
Education & Workforce See topic collection
,
Financing & Sustainability See topic collection
,
Healthcare Policy See topic collection
,
Opioids & Substance Use See topic collection
19
A model for managed behavioral health care in an academic department of psychiatry.
Type: Journal Article
Authors: P. J. Fagan, C. W. J. Schmidt, B. Cook
Year: 2002
Source:
Fagan PJ, Schmidt CWJ, Cook B. A model for managed behavioral health care in an academic department of psychiatry. Psychiatr Serv 2002;53:431-436, .
Topic(s):
Financing & Sustainability See topic collection
20
A model of the economic impact of a bipolar disorder screening program in primary care
Type: Journal Article
Authors: J. Menzin, M. Sussman, E. Tafesse, C. Duczakowski, P. Neumann, M. Friedman
Year: 2009
Source:
Menzin J, Sussman M, Tafesse E, Duczakowski C, Neumann P, Friedman M. A model of the economic impact of a bipolar disorder screening program in primary care. The Journal Of Clinical Psychiatry 2009;70:1230-1236, . https://doi.org/10.4088/JCP.08m04939.
Publication Place: United States
Abstract: OBJECTIVE: Unrecognized bipolar disorder in patients presenting with a major depressive episode may lead to delayed diagnosis, inappropriate treatment, and excessive costs. This study models the cost effectiveness of screening for bipolar disorder among adults presenting for the first time with symptoms of major depressive disorder. METHOD: A decision-analysis model was used to evaluate the outcomes and cost over 5 years of screening versus not screening for bipolar disorder. Screening was defined as a 1-time administration of the Mood Disorder Questionnaire at the initial visit followed by referral to a psychiatrist for patients screening positive for bipolar disorder. Health states included correctly diagnosed bipolar disorder, unrecognized bipolar disorder, and correctly diagnosed major depressive episodes. Model outcomes included rates of correct diagnosis of bipolar disorder and discounted costs (2006 US dollars) of screening and treating major depressive episodes. Literature was the primary source of data and was collected from September 2007 through March 2009. RESULTS: According to the model, 1,000 adults in a health plan with 1 million adult members annually present with symptoms of major depressive disorder. An additional 38 patients were correctly diagnosed with depression (unipolar or a major depressive episode) or bipolar disorder (440 with screening vs 402 without screening) through a 1-time screening for bipolar disorder. Estimated 5-year discounted costs per patient were $36,044 without screening and $34,107 with screening (savings of $1,937). Accordingly, total 5-year budgetary savings were estimated at $1.94 million. Results were most sensitive to difference in treatment costs for patients with recognized versus unrecognized bipolar disorder. CONCLUSION: A 1-time screening program for bipolar disorder, when patients first present with a major depressive episode, can reduce health care costs to managed-care plans.
Topic(s):
Financing & Sustainability See topic collection