Economic evaluations in bipolar disorder: a systematic review and critical appraisal

Pari, Anees Ahmed Abdul; Simon, Judit; Wolstenholme, Jane; Geddes, John; Goodwin, Guy M.

doi:10.1111/bdi.12213

Cited by 20 publications

(10 citation statements)

References 65 publications

(322 reference statements)

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“…The change from around 0.5‐0.7 for quality of life is both statistically and clinically significant. Regular mood monitoring may have contributed to this overall positive outcome as suggested by the earlier findings of Bopp and colleagues on steady improvement in patients using TrueColours . On the other hand, the EQ‐5D measure did not discriminate lamotrigine from placebo in the way that symptom ratings did.…”

Section: Discussionmentioning

confidence: 83%

“…In terms of total health and social care costs, estimated costs are at the lower end of the direct healthcare cost estimates derived in an earlier systematic literature review on the economic burden of bipolar disorders (US$ 8,000‐14,000 in 2009) . Several model‐based economic evaluations on lamotrigine or quetiapine were identified in another systematic review . They are, however, not comparable to this cost‐utility analysis as none of them investigated the effect of lamotrigine and quetiapine combined, while healthcare system differences in the included studies may also contribute to these cost variations …”

Section: Discussionmentioning

confidence: 92%

“…Several model‐based economic evaluations on lamotrigine or quetiapine were identified in another systematic review . They are, however, not comparable to this cost‐utility analysis as none of them investigated the effect of lamotrigine and quetiapine combined, while healthcare system differences in the included studies may also contribute to these cost variations …”

Section: Discussionmentioning

confidence: 99%

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Comparative economic evaluation of quetiapine plus lamotrigine combination vs quetiapine monotherapy (and folic acid vs placebo) in patients with bipolar depression (CEQUEL)

et al. 2018

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Objectives Although not licensed for acute bipolar depression, lamotrigine has evidence for efficacy in trials and its use is recommended in guidelines. So far there had been no prospective health economic evaluation of its use. Methods Cost‐utility analysis of the CEQUEL trial comparing quetiapine plus lamotrigine vs quetiapine monotherapy (and folic acid vs placebo in an add‐on factorial design) for patients with bipolar depression (n = 201) from the health and social care perspective. Differences in costs together with quality‐adjusted life years (QALYs) between the groups were assessed over 52 weeks using a regression‐based approach. Results Health‐related quality of life improved substantially for all randomization groups during follow‐up with no significant difference in QALYs between any of the comparisons (mean adjusted QALY difference: lamotrigine vs placebo −0.001 (95% CI: −0.05 to 0.05), folic acid vs placebo 0.002 (95% CI: −0.05 to 0.05)). While medication costs in the lamotrigine group were higher than in the placebo group (£647, P < 0.001), mental health community/outpatient costs were significantly lower (−£670, P < 0.001). Mean total costs were similar in the groups (−£180, P = 0.913). Conclusions Lamotrigine improved clinical ratings in bipolar depression compared with placebo. This differential effect was not detected using the EQ‐5D‐3L. The additional cost of lamotrigine was balanced by significant savings in some other medical costs which made its use cost neutral to the health service. Compared to placebo, folic acid produced neither clinical nor significant health economic benefits. The study supports the use of lamotrigine in combination with other drugs to treat bipolar depression.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Comparative economic evaluation of quetiapine plus lamotrigine combination vs quetiapine monotherapy (and folic acid vs placebo) in patients with bipolar depression (CEQUEL)

et al. 2018

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“…Not applicable items were excluded from scoring. As per a recently published paper conducting a similar quality assessment, we arbitrarily classified studies as low quality (fulfilled \50 % of applicable quality criteria), average quality (fulfilled between 50 and 80 % of applicable criteria) and high quality (fulfilled [80 % of applicable criteria) [36]. Tables containing lists of studies evaluated against quality criteria are provided in Online Resource 2.…”

Section: Methodsmentioning

confidence: 99%

Welfarism Versus Extra-Welfarism: Can the Choice of Economic Evaluation Approach Impact on the Adoption Decisions Recommended by Economic Evaluation Studies?

Buchanan

Wordsworth

2015

PharmacoEconomics

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A long-running debate surrounds the equivalence of the welfarist and extra-welfarist approaches to economic evaluation. There is a growing belief that the extra-welfarist approach may not necessarily provide all the information that decisionmakers require in certain contexts, e.g. evaluation of complex interventions. As the number of these interventions being evaluated increases, it is crucial that the most appropriate economic evaluation approach is used to enable decisionmakers to be confident in their adoption decisions. We conducted a literature review to evaluate the potential for the choice of economic evaluation approach to impact on the adoption decisions recommended by economic evaluation studies. We found that for every five studies applying both approaches, one shows limited or no concordance in economic evaluation results: the different approaches suggest conflicting adoption decisions, and there is no pattern to which approach provides the most convincing adoption evidence. Only one study in ten indicates which results will best inform adoption decisions. We conclude that the choice of approach can significantly impact on the adoption decisions recommended by economic evaluation studies, with conflicting results creating confusion over whether or not interventions provide good value for money. Health economists rarely provide sufficient guidance to decisionmakers to alleviate this confusion.

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“…It ranks as a major global cause of disability adjusted life years for 10–24 year olds (Gore et al 2011), and people with the disorder are seven times more likely to die an unnatural death (Hayes et al 2015). As well as the significant impact on public health, costs of the disorder are very high (Pari et al 2014), in part because of the functional losses associated with increasing episode number (Marwaha et al 2013). …”

Section: Introductionmentioning

confidence: 99%

Is treatment for bipolar disorder more effective earlier in illness course? A comprehensive literature review

Joyce

Thompson

Marwaha

2016

Int J Bipolar Disord

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BackgroundWe aimed to investigate a key element of the early intervention approach; whether treatment at an earlier stage of bipolar disorder is more effective than later in its course.MethodsA comprehensive literature review using Medline, Embase, Psychinfo, PsycArticle and Web of Science as data sources, with a subsequent narrative synthesis. Study quality was assessed using the Cochrane risk of bias method.ResultsOur search strategy yielded eight primary papers and two meta-analyses (of psychological therapies and Olanzapine) in total representing 8942 patients. Five studies focused on comparisons between first and multiple episode; the others on fewer vs more episode categories. There was a consistent finding suggesting treatment in earlier illness stage resulted in better outcomes in terms of response, relapse rate, time to recurrence, symptomatic recovery, remission, psychosocial functioning and employment. This effect was found for pharmacological (Lithium, Olanzapine, Divalproex) and psychological treatment.LimitationsThere was high risk of selection, performance and attrition bias in most studies. First admission or presentation is unlikely to equate to first episode because of duration of untreated illness. Some patients having experienced multiple episodes could be “treatment resistant”. Study heterogeneity precluded meta-analysis.ConclusionsPsychological and pharmacological treatment in the early stages of illness is more effective than in later stages of bipolar disorder across multiple domains. There is a first episode and early phase effect. Consistent with the staging model of illness findings provide evidence for the clinical utility of an early intervention approach in bipolar disorder to improve patient outcomes.

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Economic evaluations in bipolar disorder: a systematic review and critical appraisal

Cited by 20 publications

References 65 publications

Comparative economic evaluation of quetiapine plus lamotrigine combination vs quetiapine monotherapy (and folic acid vs placebo) in patients with bipolar depression (CEQUEL)

Comparative economic evaluation of quetiapine plus lamotrigine combination vs quetiapine monotherapy (and folic acid vs placebo) in patients with bipolar depression (CEQUEL)

Welfarism Versus Extra-Welfarism: Can the Choice of Economic Evaluation Approach Impact on the Adoption Decisions Recommended by Economic Evaluation Studies?

Is treatment for bipolar disorder more effective earlier in illness course? A comprehensive literature review

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