$202 billiona year, says the paper.
It measured $25 billion of it. The rest is borrowed assumptions and money people would spend anyway.
The claim
“Bipolar disorder costs the US $202 billion a year.”
Overstated About $25 billion of it was measured. The rest is a baseline and figures modelled from other studies.
- Study
- Cost-of-illness model
- Data
- Insurance claims plus published estimates
- Peer review
- Yes
- Funding
- Otsuka and Lundbeck
- Would be spent anywayWhat the same 2.5M adults cost without bipolar$82.3B
- Modeled from other papersCaregiving, jobs, mortality, crime$94.6B
- Measured in claims dataExcess healthcare spending, diagnosed patients$25.2B
The number everyone quotes
Cloutier and colleagues, writing in the Journal of Affective Disorders in 2018, put the 2015 cost of bipolar I in the United States at $202.1 billion. Advocacy decks, grant applications and news stories repeat it. Some round it to $200 billion and drop the “I.”
The paper itself reports a second, smaller figure: $119.8 billion in excess cost, the amount above what the same people would cost if they did not have bipolar. The abstract leads with the larger one.
$82 billion of the headline is the cost of being an adult in America.
That gap includes $49 billion booked as “unemployment” for the general population, whose employment rate is only 58.8%. Retirees, students and parents at home are all counted as lost wages. The headline figure carries that loss along with everything else.
One line was measured. Six were assembled.
The authors had their own data for one component: insurance claims from about 200,000 diagnosed patients, compared with matched controls. Everything else comes from multiplying figures taken out of other studies, several from around 2000, one from Sweden and one from Australia.
| Line | Excess | Built from | Problem |
|---|---|---|---|
| Caregiving | $42.8B | Survey of caregivers for “adults with mental illness” × a 2000-era registry × $23 an hour | Assumes every bipolar adult living with family has a caregiver working 25 extra hours a week |
| Healthcare | $25.2B | MarketScan claims, 2010–2015, matched controls | MeasuredHolds up for diagnosed, insured patients |
| Unemployment | $24.2B | Kupfer 2002 registry vs. all U.S. adults | Recruited, treatment-seeking sample. No matching on age or sex |
| Early death | $10.6B | Swedish national cohort | A life is valued at its expected wages |
| Work output | $9.3B | Kleinman 2005, employer claims | A single 79.9% productivity weight applied to everyone employed |
| Substance use | $6.7B | Hospitalized bipolar inpatients (2001); partly Australian cost data | Charges crime and incarceration costs to bipolar people as a class |
| Research | $0.08B | NIMH funding | Research on the condition is counted as a cost of it |
Figures from Table 1 of the paper. Caregiver healthcare costs ($0.9B) omitted for space. The caregiving line is read on its own in What bipolar costs, and who pays it.
The model disagrees with itself
- A living person with bipolar is costed at 38.5% employment. A dead one is costed at general-population employment. The model values you more once you are gone.
- The paper argues that data from two decades earlier is too old to use, then builds its largest indirect costs on samples collected around 2000.
- Costs come from the most expensive slice: diagnosed, insured for twelve straight months, in active treatment. They are then applied to 1% of all adults, including people who are undiagnosed or stable.
- Lifetime substance-use rates feed an annual cost model. Where no bipolar I figure existed, a bipolar or general mental-illness figure stood in.
Every gap is blamed on the diagnosis
Controls were matched on age, sex, health plan type and year, plus region or race depending on the insurer. Income, other illnesses, trauma and substance use were left uncontrolled, so every difference between the groups is assigned to bipolar.
The paper never asks how much of the employment gap comes from discrimination, the risk of disclosing, or jobs that will not flex. Stigma is cited once, as a reference in the introduction. The social model of disability is never weighed. It does not appear.
A person, priced as a wage
The paper uses the human capital approach. A person is a stream of earnings. Any hour not worked is a full loss, and no one else ever fills the job. The alternative friction-cost method usually gives much smaller totals. The paper does not mention it.
There is no column for what people with bipolar contribute: the wages of the roughly 40% who work, the taxes they pay, the care they give others. Under this method a person with bipolar can only subtract. The same arithmetic would produce a “burden” for any group that differs from the average.
The baseline human in this model does not have bipolar. Everything that differs from that baseline is filed as cost.
Concede the real number
Diagnosed bipolar I patients run 1.6 to 2.6 times the healthcare spending of matched controls, depending on the insurer: roughly $10,700 to $11,600 more per person each year, consistent across commercial, Medicare and Medicaid coverage. That finding is measured and it is real. We use it.
Cite $25 billion a year in excess healthcare spending.
Say what it covers: diagnosed, insured U.S. adults with bipolar I, 2015. Leave the $202 billion where it came from.
Cloutier M, Greene M, Guerin A, Touya M, Wu E. The economic burden of bipolar I disorder in the United States in 2015. Journal of Affective Disorders 226 (2018): 45–51. doi:10.1016/j.jad.2017.09.011
Second Read examines research that shapes how bipolar is talked about. We read the methods, not the abstract. See our editorial policy.
None. To challenge a claim, email [email protected] with the specific line.