Pilot evaluation of indirect costs and the impact of bipolar disorder type I

Valutazione pilota dei costi indiretti e dell’impatto del disturbo bipolare di tipo I

F.S. Mennini, A. Marcellusi, P. Sciattella, A. Pugliese

1 Economic Evaluation and HTA (EEHTA), CEIS, Faculty of Economics, University of Rome “Tor Vergata”, Italy; 2 Department of Accounting and Finance at Kingston University, London, UK; 3 Department of Demography, University of Rome “La Sapienza”, Italy; 4 Medical Department Lundbeck Italia, Milan, Italy



Bipolar I disorder, a chronic disease characterised by alternating episodes of mania and depression, is often associated with severe comorbidities, both psychiatric and metabolic, which increase the cost of healthcare in these patients. The disease also has a significant social impact, because of difficulties due to work, family issues and interpersonal relationships. In addition to the direct health care costs (hospitalisation, pharmaceutical expenditure and outpatient visits), bipolar disorder is associated with considerable indirect costs due to absence for illness and early retirement. The objective of this multicentre study, a subanalysis of a prospective observational study, was to evaluate the indirect costs associated with bipolar I disorder in an Italian context.


An ad hoc questionnaire was administered to 265 patients with bipolar I disorder diagnosed according to DSM-IV criteria and referred to 39 medical centres: indirect costs were evaluated by calculating the days of work or study with lost or reduced production capacity in the previous 3 months. The estimation of the economic burden was obtained as a product of the number of days lost and the daily income individual patient. Since the income of the patients was expressed as brackets, quantification was carried out as the range between the minimum and maximum level of each income bracket.


A total of 182 (54.9% women, 44.1% men), with a mean age of 50 years, responded to the questionnaire. Of these, 35.7% were employed and 27.5% retired, whereas the remaining 36.8% were unemployed (22.5%) and homemakers or students (14.3%). Overall, the sample declared a low-medium annual income: in fact, more than 80% of the patients earned less than € 25,000 a year. According to the responses to questionnaires, 24.2% of patients abandoned work for reasons related to bipolar disorder, 22% had reduced working hours, and 6.6% changed their job. On average, the working days lost per year per patient amounted to 93 days (median 60 days), whereas there were 66 working days with reduced productivity (median 44 days). Indirect costs for reasons related to the bipolar disorder for each patient were estimated to range from € 6009-11667, of which € 4600-8791 due to lost working days.


This study shows a strong and significant correlation between disease, work and economic aspects for patients suffering from bipolar I disorder. The disease appears to have a significant impact on indirect costs, deriving from loss of productivity, disability pensions and related benefits.

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