Bipolar
Bi
l Spectrum
S
Disorders
Di d in
i Commercially
C
i ll
Insured Children: Prevalence of Diagnoses
and Treatments Received
Date: June 29, 2010
Presenter: Stacie B. Dusetzina, PhD
Acknowledgements

Dissertation Committee Members






Richard Hansen
Hansen, PhD (Chair)
Morris Weinberger, PhD
B t Sleath,
Betsy
Sl th PhD
Bradley Gaynes, MD, MPH
Joel Farley, PhD
Funding
g


NRSA Pre-Doctoral Fellowship Sponsored by
Q
AHRQ
Cecil G. Sheps Center for Health Services
Research
What is Pediatric Bipolar Disorder?

Mood disorder characterized by periods of
mania and depression.


There are 4 subtypes (Bipolar II, II
II, NOS and
Cyclothymic Disorder)
Bipolar Disorder is costly and is associated
with significant morbidity and mortality.
3
Critical Issues in Pediatric Bipolar
p
Disorder

We don’t know how to diagnose bipolar
di d iin children.
disorder
hild

We don’t know if the drugs that are used to
treat it work (or are safe) in children
children.

Despite these problems, the most recent
estimates suggest that diagnosis and
treatment are drastically increasing in
children.
4
Objective

To provide epidemiologic information on the
prevalence of bipolar spectrum disorder
diagnoses in commercially insured children.

To provide information on psychotropic
medication use
se in children with
ith bipolar
spectrum disorders.
5
Studyy Design
g & Data Source

Retrospective Cohort Study

MarketScan Commercial Claims and
Encounters Database


January 1, 2005 – December 31, 2007
Inpatient, Outpatient & Pharmacy Claims
6
Descriptive Epidemiologic Study

Prevalence study



Cross-sections for each study year (Jan 1 – Dec 31) 2005
– 2007
Sample size: 35,526 unique children
GOALS:



Identify the diagnostic prevalence of bipolar spectrum
disorders.
Summarize patient and provider characteristics
Summarize treatments received by children with each
bipolar subtype.
7
Prevalence of Bipolar Spectrum Disorders in
Privately Insured
Annual Diagnostic Prevalence of Bipolar Spectrum Disorders by Year
Prevalence of Any Bipolar
Spectrum Disorder
2005
2006
2007
N = 5,462,802
N = 6,372,448
N = 6,309,227
n (%)
n (%)
n (%)
13,017 (0.24)
16,821 (0.26)
16,641 (0.26)
Disorder Subtype
yp at
Most Recent Visit
Bipolar I
4,834 (37.1)
6,194 (36.8)
5,870 (35.3)
Bi l II
Bipolar
1 446 (11.1)
1,446
(11 1)
1 909 (11.4)
1,909
(11 4)
1 769 (10.6)
1,769
(10 6)
Bipolar Unspecified
6,379 (49.0)
8,388 (49.9)
8,644 (51.9)
358 (2.8)
330 (2.0)
358 (2.2)
Cyclothymic Disorder
8
Patient and Provider Characteristics

Approximately 25% of children were under 12
years of age.

Comorbid mental health conditions were
common.



Attention Deficit Hyperactivity Disorder (ADHD) occurred in
> 29% of children.
D
Depressive
i Di
Disorders
d
occurred
d iin > 20% off children.
hild
Most patients received diagnoses from a
psychiatrist.
9
Treatment Use - 2007

M di ti U
Medication
Use




None: 37%
One Medication: 26%
> 1 Medication: 37%
Non Drug Treatments
Non-Drug


Electroconvulsive Therapy: RARE
Psychotherapy / Counseling: > 85%
10
Bipolar I
Bipolar II
Bipolar NOS
St
im
ul
an
ts
At
yp
ic
al
An
tip
sy
ch
ot
ic
Ty
s
pi
ca
lA
nt
ip
sy
ch
ot
ics
An
tid
ep
re
ss
an
ts
An
tic
on
vu
ls
an
ts
Li
th
iu
m
% Rec
ceiving Me
edication
Medication Use by Bipolar Subtype -2007
40
35
30
25
20
15
10
5
0
Cyclothymia
11
Study Limitations

Prescription claims data limitations:



Cannot confirm the diagnosis / diagnosis not
g a structured evaluation.
established using
Medication records are not tied to the diagnosis
p y
code,, or to a physician.
Only know about medications that were paid for
g insurance.
through
12
Study Strengths
g

Provides recent estimates of medication use
i children
in
hild
with
ith bi
bipolar
l di
disorders.
d

Provides estimates of medication use among
privately insured patients with major mental
illness.

Provides the first comparison of prevalent
treatments among children with different
p
subtypes.
yp
bipolar
13
Summary

Prevalence of bipolar spectrum disorders was
lower than anticipated.

Psychotropic medication use was similar
across all bipolar
p
subtypes.
yp

Antidepressant and stimulant use was
common across all bipolar spectrum
disorders.
14
Questions?
15