OBJECTIVES: Bipolar disorder (BD), particularly BD type I (BD-I), is a mental health disorder characterized by marked impairments in social, occupational, and personal areas of functioning, all of which have a substantial economic impact on society. While prior economic reviews of BD focused on methodologic differences between published studies, our review focused on the components of and costs associated with BD in the United States (US).

METHODS: Systematic literature searches in EMBASE, PubMed, and the Cochrane Library were performed to identify English-language studies published between 2008-2018 containing real-world evidence regarding the economic burden of BD in the US, emphasizing BD-I-specific data where available. Costs were converted to 2016 USD.

RESULTS: Applying inclusion/exclusion criteria yielded 56 studies for the review. Estimates of the annual, national economic burden of BD-I varied from $167-$204 billion (2016 USD). Of this, about one-quarter was attributed to direct health care costs. Generally, individuals with BD used health care services more frequently and required more complex care versus age- and gender‑matched individuals without BD. Drivers of higher costs included high prevalence of comorbidities; inaccurate clinical diagnosis; polypharmacy; treatment non-adherence; and patient characteristics such as short sleep patterns and insufficient access to care. Approximately 72-80% of the national economic burden of BD was attributed to indirect costs such as unemployment, lost productivity (patients and caregivers), increased health care costs for caregivers, greater utilization of social services, and premature mortality. However, few analyses monetized these different components of indirect costs.

CONCLUSIONS: The economic burden of BD is substantial. The type and complexity of health care services used to treat BD might be simplified by improving disease management, including utilization of medications that improve patient clinical outcomes and intervening to address barriers to treatment such as patient access to care.