Academic journal article Applied Health Economics and Health Policy

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

Academic journal article Applied Health Economics and Health Policy

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

Article excerpt

Published online: 17 May 2014

© Springer International Publishing Switzerland 2014

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.

1 Introduction

Bipolar disorder (BD) is a severe form of mental illness typified by recurring episodes of mania and depression, or mixture of both, separated by periods of normal mood [1]. Almost all bipolar patients experience both manic and depressive episodes [2]. During such episodes, a patient's health-related quality-of-life (HRQoL) can change both rapidly and markedly, leading to serious functional and occupational consequences [3-5]. Common symptoms of mania include elevated mood, decreased need of sleep, increased activity and racing thoughts, while symptoms of depression include empty mood, interrupted sleep, decreased activity and loss of enjoyment [6, 7]. The prevalence of BD within European citizens was found to be around 6 % [8], while for US citizens it was approximately between 2 and 7 % [9]. A large proportion of BD patients experience a high risk of multiple relapses and frequent oscillations in symptom severity that often results in hospitalisation [10]. Despite its severely disabling nature, BD can be managed effectively through pertinent pharmacotherapeutic interventions that may reduce the risk of relapse and improve survival, particularly in patients who adhere with prescribed treatments.

A number of pharmacotherapeutics are indicated for the treatment of mania and/or depression, but these interventions have varying effectiveness. Personalised pharmacotherapy is vital for the treatment success of BD, especially with regard to adverse effects and patient preference, tolerance and adherence [11, 12]. The main targets of pharmacotherapeutic interventions in patients with BD are preventing relapse and supporting sustained remission from episodic symptoms, but the cost of interventions usually results in substantial spending. …

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