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Indirect Costs Associated With Nonadherence to Treatment for Bipolar Disorder

Bagalman, Erin MSW; Yu-Isenberg, Kristina S. PhD, RPh; Durden, Emily PhD; Crivera, Concetta PharmD, MPH; Dirani, Riad PhD; Bunn, William B. III MD, JD, MPH

Journal of Occupational and Environmental Medicine: May 2010 - Volume 52 - Issue 5 - p 478-485
doi: 10.1097/JOM.0b013e3181db811d
Original Articles

Objective: To examine the association between treatment adherence and indirect productivity costs within a cohort of commercially insured employees with bipolar disorder in the United States.

Methods: Adults diagnosed with bipolar disorder who had at least one prescription claim for a mood stabilizer or atypical antipsychotic, with 6 months prior and 12 months subsequent continuous medical and prescription coverage, were identified in the MarketScan research databases (2000–2005). Two-part multiple regression models estimated the association between adherence (medication possession ratio ≥0.80) and costs of absence, short-term disability, and workers' compensation.

Results: Of 1258 eligible employees, only 35.3% were adherent. Relative to adherent employees, nonadherent employees had higher adjusted indirect costs due to absence (+$771.41), short-term disability (+$284.72), and workers' compensation (+$360.63).

Conclusions: Employers incur greater indirect costs when employees are not adherent to bipolar treatment.

From the Healthcare business of Thomson Reuters (Ms Bagalman, Dr Durden), Washington, DC; Ortho McNeil Janssen Scientific Affairs, LLC (Dr Yu-Isenberg, Dr Crivera, Dr Dirani), Titusville, NJ; and Navistar, Inc. and Northwestern University School of Medicine (Dr Bunn), Chicago, Ill.

CME Available for this Article at

Dr Emily Durden is currently at Covance Market Access. Dr Kristina Yu-Isenberg is currently at Novartis Pharmaceuticals Corporation, Southeast Operating Unit, Raleigh, NC.

J. Erin Bagalman is employed by Thomson Reuters. Kristina Yu-Isenberg is employed by and has stock ownership or options in Novartis. Emily D. Durden was employed by Thomson Reuters. Concetta Crivera is employed by Ortho-McNeil Janssen Scientific Affairs, LLC. Riad Dirani is employed by and has stock ownership or options in Ortho-McNeil Janssen Scientific Affairs, LLC. William B. Bunn has no financial interest in this research.

This research was supported by funding from Ortho-McNeil Janssen Scientific Affairs, LLC.

The JOEM Editorial Board and planners have no financial interest related to this research.

Address correspondence to: Erin Bagalman, MSW, The Healthcare business of Thomson Reuters, 4301 Connecticut Avenue NW, Suite 330, Washington, DC 20008; E-mail:

©2010The American College of Occupational and Environmental Medicine