title: Economic outcomes associated with atypical antipsychotics in bipolar disorder: a systematic review.
abstract: OBJECTIVE
  Bipolar disorder is a serious condition that is costly to the health care system. Atypical antipsychotics are more expensive than conventional treatments. From a policy-making perspective, the additional cost must be justified by improved outcomes. The objective of this study was to conduct a systematic review to determine the relative costs and cost-effectiveness associated with atypical antipsychotics in bipolar disorder.
  
  
  METHODS
  We conducted a systematic review of the literature in PubMed and EMBASE from January 1985 through October 2005, including published studies and conference proceedings. Databases were searched using predefined terms.
  
  
  METHODS
  Studies were included if they were claims data analyses, trial-based economic evaluations, or cost-effectiveness analyses using models. Data were extracted using predefined tables.
  
  
  RESULTS
  Fourteen studies were identified. Seven were medical claims database analyses, 4 were trial-based economic evaluations, and 3 were cost-effectiveness models. Eight of these studies were conference proceedings. The studies did not provide sufficient information to determine any ranking of interventions in terms of least to most costly in overall resource consumption or in terms of their relative cost-effectiveness. Where comparable, results tended to be inconsistent.
  
  
  CONCLUSIONS
  There is a scarcity of economic studies in this field. A reference case outlining how to address the complex interplay between effectiveness, safety, adherence, and quality of life and their impact on resource use and costs is needed to contribute to improving the treatment of patients with bipolar disorder while making the best use of scarce health resources.
authors.affiliation: United BioSource Corporation, Bethesda, Md. ; MLG Consulting Services, Inc., Chadds Ford, Pa. ; and AstraZeneca, Wilmington, Del. . Dr. Rajagopalan is now with Biogen Idec.
authors.forename: Rachael L
authors.initials: RL
authors.lastname: Fleurence
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Chatterton
authors.forename: Julia M
authors.initials: JM
authors.lastname: Dixon
authors.forename: Kitty
authors.initials: K
authors.lastname: Rajagopalan