Cost effectiveness of quetiapine in patients with acute bipolar depression and in maintenance treatment after an acute depressive episode

Background: Bipolar disorder has a significant impact upon a patient's quality of life, imposing a considerable economic burden on the individual, family members and society as a whole. Several medications are indicated for the acute treatment of mania and depression associated with bipolar disorder as well as for maintenance therapy; however, these have varying efficacy, tolerability and costs. Objective: The objective of this study was to develop a new discrete-event simulation model to analyse the long-term consequences of pharmacological therapy for the management of bipolar I and II disorders (acute treatment of episodes of mania and depression as well as maintenance therapy). Methods: Probabilities of remission and relapse were obtained from clinical trial data and meta-analyses. Costs (year 2011 values) were assessed from a UK healthcare payer's perspective, and included pharmacological therapy and resource use associated with the treatment of mood events and selected adverse events. The health effects were measured in terms of QALYs. Results: For a patient starting with acute depression or in remission at 40 years of age (which was the average age in the clinical trials), quetiapine 300mg/day was a cost-effective strategy compared with olanzapine 15mg/day over a 5-year time frame. With acute bipolar depression as a starting episode, the 5-year medical costs were d323 higher and QALYs were 0.038 higher for quetiapine compared with olanzapine, corresponding to a cost-effectiveness ratio of d8600 per QALY gained. Conclusion: Compared with olanzapine, the results suggest that quetiapine is cost effective as a maintenance treatment for bipolar depression. Adis