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Cost-effectiveness of clinical interventions for reducing the global burden of bipolar disorder.

Chisholm D, van Ommeren M, Ayuso-Mateos JL, Saxena S

Department of Health System Financing, Evidence and Information for Policy (EIP), World Health Organization, 1211 Geneva, Switzerland. ChisholmD@who.int

BACKGROUND: Bipolar disorder has been ranked seventh among the worldwide causes of non-fatal disease burden. AIMS: To estimate the cost-effectiveness of interventions for reducing the global burden of bipolar disorder. METHOD: 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.

Published 1 December 2005 in Br J Psychiatry, 187: 559-67.
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