Cost-effectiveness of clinical interventions for reducing the global burden of bipolar disorder

Abstract

Background: Bipolar disorder has been ranked seventh among the worldwide causes of non-fatal disease burden. Aims: To estimate the cost-effectiveness of interventions for reducing the global burden of bipolar disorder. Method: Hospital- and community-based delivery of two generic mood stabilisers (lithium and valproic acid), alone and in combination with psychosocial treatment, were modelled for 14 global sub-regions. A population model was employed to estimate the impact of different strategies, relative to no intervention. Total costs (in inter-national dollars (1$)) and effectiveness (disability-adjusted life years (DALYs) averted) were combined to form cost-effectiveness ratios. Results: Baseline results showed lithium to be no more costly yet more effective than valproic acid, assuming an anti-suicidal effect for lithium but not for valproic acid. Community-based treatment with lithium and psychosocial care was most cost-effective (cost per DALY averted: 1$2165-6475 in developing sub-regions; 1$5487-21 123 in developed sub-regions). Conclusions: Community-based interventions for bipolar disorder were estimated to be more efficient than hospital-based services, each DALY averted costing between one and three times average gross national income.