title: Cost-effectiveness of asenapine in the treatment of patients with bipolar I disorder with mixed episodes in an Italian context.
abstract: BACKGROUND
  Bipolar disorder is a chronic disease characterized by periods of mania or hypomania, depression, or a combination of both (mixed state). Because bipolar disorder is one of the leading causes of disability, it represents an important economic burden on society. Asenapine (ASE) is a new second-generation antipsychotic developed and approved for the treatment of manic or mixed episodes associated with bipolar disorder. The objective of the present study was to assess the cost-effectiveness of ASE compared to olanzapine (OLA) in the treatment of patients experiencing mixed episodes associated with bipolar I disorder in the context of the Italian National Health Service (NHS).
  
  
  METHODS
  A pharmacoeconomic model was developed to simulate the management of Italian bipolar I patients with mixed episodes over a 5-year time horizon by combining clinical parameters with resource utilization. An expert panel of Italian psychiatrists and health economists was responsible for adapting a UK model to the Italian context. The primary outcome measure of the economic evaluation was the incremental cost effectiveness ratio, where effectiveness is measured in terms of quality adjusted life-years gained. Scenario analyses, sensitivity analyses, and a probabilistic sensitivity analysis were performed to test the robustness of the model.
  
  
  RESULTS
  This pharmacoeconomic model showed that ASE resulted to be dominant over OLA; in fact, ASE was associated with lower direct costs (derived largely by the savings from hospitalizations avoided) and also generated a better quality of life. Results were robust to changes in key parameters; both scenario analyses and sensitivity analyses demonstrated model reliability.
  
  
  CONCLUSIONS
  Results from this study suggest that the management of bipolar I patients with mixed episodes using ASE as alternative to OLA can lead to cost saving for the Italian NHS and improve patients quality of life.
authors: Department of Psychiatry, Lundbeck Italia S.p.A, Milan, Italy.
authors: Chiara
authors: C
authors: Caresano
authors: Guido
authors: G
authors: Di Sciascio
authors: Andrea
authors: A
authors: Fagiolini
authors: Giuseppe
authors: G
authors: Maina
authors: Giulio
authors: G
authors: Perugi
authors: Claudio
authors: C
authors: Ripellino
authors: Claudio
authors: C
authors: Vampini
mesh_terms: D014150:Antipsychotic Agents / Q000191:economics* / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000191:economics / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D003986:Dibenzocycloheptenes; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006576:Heterocyclic Compounds, 4 or More Rings / Q000191:economics* / Q000627:therapeutic use*; D006801:Humans; D007558:Italy; D017059:Models, Econometric; D000077152:Olanzapine; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D015203:Reproducibility of Results
chemical_list: D014150:Antipsychotic Agents; D003986:Dibenzocycloheptenes; D006576:Heterocyclic Compounds, 4 or More Rings; D001569:Benzodiazepines; C522667:asenapine; D000077152:Olanzapine