Cost-effectiveness of clinical interventions for reducing the global burden of bipolar disorder.
BACKGROUND
Bipolar disorder has been ranked seventh among the worldwide causes of non-fatal disease burden.


OBJECTIVE
To estimate the cost-effectiveness of interventions for reducing the global burden of bipolar disorder.


METHODS
Hospital- and community-based delivery of two generic mood stabilisers (lithium and valproic acid), alone and in combination with psychosocial treatment, were modelled for 14 global sub-regions. A population model was employed to estimate the impact of different strategies, relative to no intervention. Total costs (in international dollars (I$)) and effectiveness (disability-adjusted life years (DALYs) averted) were combined to form cost-effectiveness ratios.


RESULTS
Baseline results showed lithium to be no more costly yet more effective than valproic acid, assuming an anti-suicidal effect for lithium but not for valproic acid. Community-based treatment with lithium and psychosocial care was most cost-effective (cost per DALY averted: I$2165-6475 in developing sub-regions; I$5487-21123 in developed sub-regions).


CONCLUSIONS
Community-based interventions for bipolar disorder were estimated to be more efficient than hospital-based services, each DALY averted costing between one and three times average gross national income.
Chisholm
Dan
D
Department of Health System Financing, Evidence and Information for Policy (EIP), World Health Organization, 1211 Geneva, Switzerland. ChisholmD@who.int
van Ommeren
Mark
M
Ayuso-Mateos
Jose-Luis
JL
Saxena
Shekhar
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018692:Antimanic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy / Q000191:economics / Q000628:therapy*; D003156:Community Mental Health Services / Q000191:economics; D017281:Cost of Illness; D003362:Cost-Benefit Analysis / Q000379:methods; D004185:Disability Evaluation; D005260:Female; D014943:Global Health; D006760:Hospitalization / Q000191:economics; D006801:Humans; D018020:Lithium Compounds / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D012944:Social Support; D016896:Treatment Outcome; D014635:Valproic Acid / Q000627:therapeutic use; D000092864:Suicide Prevention
D018692:Antimanic Agents; D018020:Lithium Compounds; D014635:Valproic Acid