Full title: Efficiency in the treatment and follow-up of patients with bipolar disorder — adherence, variability, and costs in the Canary Islands Health Service (SCS) (BIPOLAR-COST)
Funded by: Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC)
Granted funding: €14,000.00
Duration: 2 years (2026–2027)
Principal investigator: Tasmania del Pino Sedeño
Associate researchers: Yadira González Hernández, Diego Infante Ventura, Alejandra Abrante Luis, Francisco Javier Acosta Artiles, Pedro Serrano Pérez, Aránzazu Hernández Yumar, Francisco Estupiñán Romero, Miguel Ángel García Bello, Benjamín Rodríguez Díaz, Beatriz González de León, Isabel Hurtado Navarro
Background:
Bipolar disorder is a major public health problem worldwide, affecting around 37 million people and approximately 1% of the population in Spain. It is a chronic and highly disabling condition, associated with a reduced life expectancy—up to 13 years less—and a high risk of suicide, in addition to generating a significant economic and social impact. Despite the existence of effective pharmacological and psychological treatments, important challenges persist such as underdiagnosis, stigma, lack of treatment adherence, and the frequent use of polypharmacy, which may increase adverse effects and complicate clinical management. These difficulties contribute to a significant gap between optimal care and real-world practice. In this context, the use of real-world data (RWD) emerges as a key tool to assess the quality of care, treatment adherence, and its health and cost implications, with the aim of improving healthcare decision-making and outcomes in patients with bipolar disorder.
Objectives:
(O1) To analyse therapeutic adherence, psychotropic polypharmacy, and the appropriateness of prescriptions in patients with bipolar disorder in the Canary Islands Health Service (SCS), considering the influence of social determinants of health.
(O2) To estimate the cost of treatment and follow-up of patients with bipolar disorder in the SCS and the economic impact of potentially inappropriate medication (PIM) prescriptions or lack of adherence.
Method:
Design:
Multimethod study: (O1) State-of-the-art review and a population-based retrospective, longitudinal, multicentre cohort study using real-world data (RWD) from the SCS. (O2) Cost estimation based on healthcare resource use and comparison with the theoretical cost of treatment and follow-up that the patient could have received according to clinical recommendations.
Participants: (O1, O2) Individuals aged over 18 years diagnosed with bipolar disorder (ICD-10: F30–F31) and receiving psychotropic treatment in primary and specialised care within the SCS.
Data sources: (O1, O2) Electronic health records from primary care (Drago AP) and specialised care (DRAGO-AE), the Canary Islands Psychiatric Case Registry (RECAP), Continuous Electronic Prescription system, and the National Institute of Statistics (INE).
Main outcome measures: (O1) Therapeutic adherence (Medication Possession Ratio), polypharmacy (according to ATC classification and international criteria), and PIM (Beers, STOPP, and PRISCUS criteria). (O2) Direct healthcare costs per patient (adherent/non-adherent, polypharmacy/no polypharmacy, appropriate/inappropriate prescriptions) from the SCS perspective; avoidable cost associated with deviations from clinical recommendations will be calculated.
Analysis: (O1) Multivariable logistic regression models to explore clinical and social factors associated with adherence, polypharmacy, and inappropriate prescribing. (O2) Cost analysis using descriptive and inferential statistics; sensitivity analysis of avoidable costs.
Contact person: Tasmania del Pino Sedeño (tasmania.delpino@sescs.es)