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A Systematic and Critical Review of Model-Based Economic Evaluations of Pharmacotherapeutics in Patients with Bipolar Disorder

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Abstract

Background

Bipolar disorder (BD) is a chronic and relapsing mental illness with a considerable health-related and economic burden. The primary goal of pharmacotherapeutics for BD is to improve patients’ well-being. The use of decision-analytic models is key in assessing the added value of the pharmacotherapeutics aimed at treating the illness, but concerns have been expressed about the appropriateness of different modelling techniques and about the transparency in the reporting of economic evaluations.

Objectives

This paper aimed to identify and critically appraise published model-based economic evaluations of pharmacotherapeutics in BD patients.

Methods

A systematic review combining common terms for BD and economic evaluation was conducted in MEDLINE, EMBASE, PSYCINFO and ECONLIT. Studies identified were summarised and critically appraised in terms of the use of modelling technique, model structure and data sources. Considering the prognosis and management of BD, the possible benefits and limitations of each modelling technique are discussed.

Results

Fourteen studies were identified using model-based economic evaluations of pharmacotherapeutics in BD patients. Of these 14 studies, nine used Markov, three used discrete-event simulation (DES) and two used decision-tree models. Most of the studies (n = 11) did not include the rationale for the choice of modelling technique undertaken. Half of the studies did not include the risk of mortality. Surprisingly, no study considered the risk of having a mixed bipolar episode.

Conclusions

This review identified various modelling issues that could potentially reduce the comparability of one pharmacotherapeutic intervention with another. Better use and reporting of the modelling techniques in the future studies are essential. DES modelling appears to be a flexible and comprehensive technique for evaluating the comparability of BD treatment options because of its greater flexibility of depicting the disease progression over time. However, depending on the research question, modelling techniques other than DES might also be appropriate in some cases.

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Funding

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Conflict of interest

The author declares no conflict of interest.

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Authors and Affiliations

  1. Manchester Centre for Health Economics, Institute of Population Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK

    Syed Mohiuddin

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Appendix: Electronic Search Strategy

Appendix: Electronic Search Strategy

  1. 1.

    (bipolar disorder or bipolar I disorder or bipolar 1 disorder or bipolar II disorder or bipolar 2 disorder).mp.

  2. 2.

    (rapid-cycling bipolar disorder or rapid cycling bipolar disorder).mp.

  3. 3.

    (cyclothymic-disorder or cyclothymic disorder or cyclothymia).mp.

  4. 4.

    bipolar disorder not otherwise specified.mp.

  5. 5.

    bipolar affective disorder.mp.

  6. 6.

    (manic-depressive disorder or manic depressive disorder).mp.

  7. 7.

    (manic-depression or manic depression or mania-depression or mania depression).mp.

  8. 8.

    or/1–7.

  9. 9.

    (economic$ analys$ or economic$ evaluation$).mp.

  10. 10.

    (cost-effective$ or cost effective$).mp.

  11. 11.

    (cost–utility or cost utility).mp.

  12. 12.

    (cost–benefit or cost benefit).mp.

  13. 13.

    13. (cost-minimi$ or cost minimi$).mp.

  14. 14.

    (cost-consequence$ or cost consequence$).mp.

  15. 15.

    (value-of-information analys$ or value of information analys$).mp.

  16. 16.

    (decision-tree model$ or decision tree model$).mp.

  17. 17.

    (markov model$ or state-transition model$ or state transition model$).mp.

  18. 18.

    simulation model$.mp.

  19. 19.

    (individual-patient simulation or individual patient simulation).mp.

  20. 20.

    (individual patient-level model$ or individual patient level model$).mp.

  21. 21.

    (health-economic$ model$ or health economic$ model$).mp.

  22. 22.

    (decision-analytic$ model$ or decision analytic$ model$).mp.

  23. 23.

    (quality-adjusted life-year$ or quality-adjusted life year$ or QALY$).mp.

  24. 24.

    (disability-adjusted life-year$ or disability-adjusted life year$ or DALY$).mp.

  25. 25.

    or/9–24.

  26. 26.

    8 and 25.

  27. 27.

    limit 26 to English language.

  28. 28.

    remove duplicates from 27.

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Mohiuddin, S. A Systematic and Critical Review of Model-Based Economic Evaluations of Pharmacotherapeutics in Patients with Bipolar Disorder. Appl Health Econ Health Policy 12, 359–372 (2014). https://doi.org/10.1007/s40258-014-0098-5

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