NEWER DRUGS FOR BIPOLAR AFFECTIVE DISORDER

A rapid and systematic review and economic evaluation of the clinical and cost-effectiveness of newer drugs for treatment of mania associated with bipolar affective disorder

Background

Bipolar disorder is a relatively common, recurrent and sometimes chronic disorder that leads to harmful effects for the individual's psychological, professional and social welfare. Treatment is dependent on the phase of the disorder being experienced, for example acute mania, depression or maintenance therapy to prevent future manic or depressive episodes. This review evaluated the clinical and cost-effectiveness of quetiapine, olanzapine and valproate semisodium in the acute treatment of mania associated with bipolar disorder.

Findings

In comparison with placebo, quetiapine, olanzapine and valproate semisodium appear superior in reducing manic symptoms, but all the drugs were associated with adverse events. In comparison with lithium, no significant differences were found for olanzapine, quetiapine and valproate semisodium in terms of effectiveness. All the drugs were associated with adverse events.

The current evidence concerning the cost-effectiveness of alternative drugs for bipolar disorder is extremely limited from an NHS perspective. Estimates would be most appropriately derived by ensuring that future trials are designed to assess both effectiveness and cost-effectiveness considerations. The cost-effectiveness estimates would be most appropriate if they were based on a direct 'head-to-head' analysis of all relevant prophylactic treatments, rather than on a partial comparison with placebo only.

Conducted by: C Bridle1, S Palmer2, A-M Bagnall1, J Darba2, S Duffy1, M Sculpher2, R Riemsma1

1. Centre for Reviews and Dissemination; 2. Centre for Health Economics

Further details

Project page on HTA Programme website

Related guidance

Commissioned to inform NICE Technology Appraisal 66: The clinical effectiveness and cost effectiveness of new drugs for bipolar disorder. London: National Institute for Clinical Excellence; 2003

Publications

Bridle C, Palmer S, Bagnall AM, Darba J, Duffy S, Sculpher M, Riemsma R. A rapid and systematic review and economic evaluation of the clinical and cost effectiveness of newer drugs for treatment of mania associated with bipolar affective disorder. Health Technol Assess. 2004;8(19):1-200

Funding

Commissioned by the HTA Programme on behalf of NICE's Technology Assessment Report (TAR) process