Table 3 Examples of big data projects related to health policy for patients with bipolar disorder
Country | Description | Primary finding | Data source | Number of subjects analyzed (N) | Reference |
|---|---|---|---|---|---|
France | Impact of longitudinal continuity of care with the same community psychiatrist on mortality rate of patients with mental disorders | Higher the continuity of care the lower likelihood of death, especially in those with BP, major depressive disorder and schizophrenia (SCZ) | France national claims data 2007–2010 | 14,515 patients visiting psychiatrist at least once, tracked over 3 years | Hoertel et al. 2014 |
UK | Investigation of delay between first visit to a mental health service and a diagnosis of BP | Median diagnostic delay was 62Â days; median treatment delay was 31Â days | SLAM register data between 2007 and 2012 | 1364 diagnosed with BP | Patel et al. 2015b |
UK | Investigation of mortality after hospital discharge with principal diagnosis of BP or SCZ | Standardized mortality ratios about double general population. For BP, increased from 1.3 in 1999 to 1.9 in 2006. About 3/4 of all deaths from natural causes | English national hospital and death registries from 1999 and 2006 | 100,851 hospital discharges for patients with BP and 272,248 with SCZ | Hoang et al. 2011 |
US | Impact of state Medicaid formulary restrictions on total medical costs for patients with BP or SCZ | Medication adherence declined due to formulary restrictions. Total medical costs increased | Medicaid claims from 24 states 2001–2008 | 170,596 patients with BP and 117,908 with SCZ | Seabury et al. 2014 |
US | Impact of requiring prior authorization (PA) for more expensive medications on the discontinuation of antipsychotics and anticonvulsants | Higher rates of discontinuation of all medication treatment. No increase in use of preferred drugs (not requiring PA) | Medicaid and Medicare claims 2001–2004 in Maine | N = 5336 Maine N = 1376 New Hampshire (comparison state) | Zhang et al. 2009 |
US | Impact of prior authorization and copayments policy on medication continuity | Prior authorization and copayments decreased medication continuity. (High continuity in 54Â % of those with BP and 64Â % of those with SCZ) | Medicaid claims from 22 states in 2007 | 33,234 patients with BP and 91,451 with SCZ | Brown et al. 2013 |
US | Impact of adherence to and persistence with atypical antipsychotics on health care costs | Good adherence and persistence led to lower costs | Commercial health insurance claims 2007–2013 | 32,374 patients with diagnosis of BP or SCZ and prescription for oral antipsychotic | Jiang and Ni 2015 |
US | Association of frequent psychiatric interventions over 1 year on health care utilization and costs in patients with BP I | Patients needing frequent psychiatric interventions had higher psychiatric and general medical utilization and costs in following year | Commercial insurance claims 2004–2007 | 7260 patients with frequent psychiatric interventions and 11,571 without | Bagalman et al. 2011 |
US | Examine conformance to practice guidelines for children/adolescents with BP | Most received recommended therapy but only a minority received drug monitoring and/or recommended psychotherapy | Medicaid in Ohio 2006–2010 | 4047 youths aged 15–18 years with new episode of BP | Fontanella et al. 2015 |
US | Estimate number of emergency department (ED) visits by adults involving psychiatric medications | Antipsychotics and lithium involved in more visits relative to rate at which prescribed. Half of ED visits involving psychiatric medications were for patients 19–44 years | National surveillance database from 63 hospitals between 2009 and 2011 | 89,094 ED visits annually for therapeutic use of psychiatric medications in patients ≥19 years | Hampton et al. 2014 |
US | Evaluate if patients with SCZ and BP received comprehensive treatment by state | In each state, only 45 % with BP, and 47 % with SCZ had a continuous medication supply. About 25 % of beneficiaries had no mental health visit | Medicaid claims in 21 states + DC in 2007 | 40,609 with BP; 102,884 with SCZ | Brown et al. 2015 |
US | Drug utilization patterns for newly initiated atypical antipsychotic | Low adherence and persistence: 63.4 % discontinued index therapy, and majority of these (69.5 %) did not resume any antipsychotic | Commercial insurance between 2002 and 2008 | 16,807 patients ≥18 years with BP I | Chen et al. 2013 |