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A Systematic Review and Critical Appraisal of Economic Evaluations of Pharmacological Interventions for People with Bipolar Disorder

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Abstract

Background

Bipolar disorder (BD) is a chronic mood disorder that causes substantial psychological and financial burden. Various pharmacological treatments are effective in the management and prevention of acute episodes of BD. In an era of tighter healthcare budgets and a need for more efficient use of resources, several economic evaluations have evaluated the cost effectiveness of treatments for BD.

Objective

The aim of this study was to systematically review and appraise published economic evaluations of pharmacological interventions for BD.

Methods

A systematic search combining search terms specific to BD with a health economics search filter was conducted on six bibliographic databases (EMBASE, MEDLINE, PsycINFO, HTA, NHS EED, CENTRAL) in order to identify trial- or model-based full economic evaluations of pharmacological treatments of any phase of the disorder that were published between 1 January 1990 and 18 December 2015. Studies that met the inclusion criteria were critically appraised using the Quality of Health Economic Studies (QHES) checklist, and synthesised in a narrative way.

Results

The review included 19 economic studies, which varied with regard to the type and number of interventions assessed, the study design, the phase of treatment (acute or maintenance), the source of efficacy data and the method for evidence synthesis, the outcome measures, the time horizon and the countries/settings in which the studies were conducted. The study quality was variable but the majority of studies were of high or fair quality.

Conclusion

Pharmacological interventions are cost effective, compared with no treatment, in the management of BD, both in the acute and maintenance phases. However, it is difficult to draw safe conclusions on the relative cost effectiveness between drugs due to differences across studies and limitations characterising many of them. Future economic evaluations need to consider the whole range of treatment options available for the management of BD and adopt appropriate methods for evidence synthesis and economic modelling, to explore more robustly the relative cost effectiveness of pharmacological interventions for people with BD.

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Acknowledgements

The authors wish to thank Eric Slade, who agreed to act as a third reviewer to resolve any disagreements between the authors regarding the selection of eligible studies for the review and the quality assessment of included studies.

Author Contributions

IM designed the systematic review and carried out the literature searches. Both authors  assessed the eligibility of studies against inclusion criteria; IM did the data extraction, which was subsequently checked by JL. Both authors undertook the quality appraisal of included studies and interpreted the review findings. IM drafted the manuscript to which JL contributed. Both authors approved the final version of the manuscript.

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Authors and Affiliations

  1. National Guideline Alliance (NGA), Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK

    Ifigeneia Mavranezouli

  2. Centre of Economic Evaluation, Trimbos Institute (The Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands

    Joran Lokkerbol

  3. Rob Giel Research Centre, University Medical Centre Groningen, Groningen, The Netherlands

    Joran Lokkerbol

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  1. Ifigeneia Mavranezouli
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Correspondence to Ifigeneia Mavranezouli.

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Ifigeneia Mavranezouli and Joran Lokkerbol declare they have no conflicts of interest.

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Mavranezouli, I., Lokkerbol, J. A Systematic Review and Critical Appraisal of Economic Evaluations of Pharmacological Interventions for People with Bipolar Disorder. PharmacoEconomics 35, 271–296 (2017). https://doi.org/10.1007/s40273-016-0473-1

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