Cost-effectiveness of treatment for bipolar disorders

Abstract

This chapter focuses on a review the cost-effectiveness studies of bipolar disorder (BD) published in the past 10 years in order to present the main methodological issues related to economic evaluations of this topic. A systematic search of the was performed to include articles on the cost-effectiveness of any management strategy for BD, published in English, and spanning the period of January 2005 to June 2016. Five electronic databases were assessed, namely, the National Health Services-Health Economic Evaluation Database, the Health Technology Assessment Database, MEDLINE, and the Cumulative Index to Nursing and Allied Health Literature. A total of 141 citations were found. After screening, 24 studies were selected, of which 18 were original articles and 6 were systematic reviews. Of the eligible studies, the majority were from the United Kingdom and United States. Few studies were not funded by the pharmaceutical industry. Considering methodology, four studies were trial-based economic evaluations and the others were model-based economic evaluations. The number of subjects enrolled in the reported trials varied from 103 to 431. Most studies focused on the maintenance phase of BD treatment. New atypical antipsychotics were the most commonly evaluated interventions, with placebo and traditional treatments as comparators. Few articles evaluated classical mood stabilizers (lithium, valproate, carbamazepine) in an economic assessment. Atypical antipsychotics were the most cost-effective intervention studied. When one considers the economic evaluations, quetiapine, olanzapine, and aripiprazole are considered to be good strategies in the maintenance treatment of BD.