Burden of Bipolar I Disorder on Clinical, Economic, and Humanistic Outcomes: Matched Analysis of US National Health and Wellness Survey Data

This work was sponsored by Alkermes, Inc. BACKGROUND: Bipolar I disorder (BD-I) is associated with a risk of obesity and related cardiometabolic sequelae, but real-world impacts of these risks are not well understood. OBJECTIVE: To evaluate clinical, humanistic, and economic outcomes in adults with or without BD-I and assess impact of increasing body mass index (BMI) in BD-I. METHODS: Respondents to the 2016/2020 National Health and Wellness Survey with a self-reported physician’s diagnosis of BD-I were matched to controls without BD-I (1:2 greedy propensity score matching on demographic/health characteristics). Outcomes were compared between cohorts and across BMI categories for respondents with BD-I. RESULTS: Results from 5418 respondents (BD-I, n=1806; controls, n=3612) were analyzed. Most respondents were female (64.5%), White (62.8%), and unemployed (54.2%) and averaged 38.7 years old. BD-I was associated with increased risks for insomnia (odds ratio [OR]=4.23), asthma (OR=1.86), sleep apnea (OR=1.84), and hypertension (OR=1.57), among others, with lower quality-of-life, higher productivity losses (work productivity loss: 66.7% vs 57.4%), higher indirect/direct healthcare costs, and higher mean healthcare resource utilization (emergency room visits: 1.7 vs 1.0; outpatient visits: 11.9 vs 5.9) vs controls. In respondents with BD-I, obesity added further burden across many (eg, cardiovascular events, liver disease, work/impairments, quality-of-life, total indirect/direct healthcare costs, and healthcare resource utilization activity) important outcomes. CONCLUSIONS: BD-I is associated with increased risk of medical comorbidities, lower quality-of-life, and higher indirect/direct healthcare costs vs controls without BD-I. Treatment- or disease-associated obesity increases the burden of these clinical, humanistic, and economic risks in this vulnerable patient population.