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National Collaborating Centre for Mental Health (UK). Bipolar Disorder: The NICE Guideline on the Assessment and Management of Bipolar Disorder in Adults, Children and Young People in Primary and Secondary Care. London: The British Psychological Society and The Royal College of Psychiatrists; 2014 Sep. (NICE Clinical Guidelines, No. 185.)

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  • April 2018: Footnotes and cautions have been added and amended to link to the MHRA's latest advice and resources on sodium valproate. Sodium valproate must not be used in pregnancy, and only used in girls and women when there is no alternative and a pregnancy prevention plan is in place. This is because of the risk of malformations and developmental abnormalities in the baby. November 2017: Footnotes for some recommendations were updated with current UK marketing authorisations and MHRA advice. Links to other guidelines have also been updated. Some research recommendations have been stood down. See these changes in the short version of the guideline.

April 2018: Footnotes and cautions have been added and amended to link to the MHRA's latest advice and resources on sodium valproate. Sodium valproate must not be used in pregnancy, and only used in girls and women when there is no alternative and a pregnancy prevention plan is in place. This is because of the risk of malformations and developmental abnormalities in the baby. November 2017: Footnotes for some recommendations were updated with current UK marketing authorisations and MHRA advice. Links to other guidelines have also been updated. Some research recommendations have been stood down. See these changes in the short version of the guideline.

Cover of Bipolar Disorder

Bipolar Disorder: The NICE Guideline on the Assessment and Management of Bipolar Disorder in Adults, Children and Young People in Primary and Secondary Care.

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APPENDIX 32Health Economics – Evidence Tables

Abbreviations

Ari

aripiprazole

Car

carbamazepine

CBT

cognitive behavioural therapy

CI

confidence interval

CPN

community psychiatric nurse

DSM-IV

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition

EPA

eicosapentaenoic acid

GP

general practitioner

HRQoL

health-related quality of life

ICER

incremental cost-effectiveness ratio

Imi

imipramine

Lam

lamotrigine

Li

lithium

MDQ

Mood Disorder Questionnaire

MRS

Mania Rating Scale

MS

mood stabiliser

NA

not applicable

NHS

National Health Service

Olz

olanzapine

QALY

quality-adjusted life year

Que

quetiapine

RCT

randomised controlled trial

SD

standard deviation

SHO

senior house officer

Val

valproate

Ven

venlafaxine

WTP

willingness to pay

YMRS

Young Mania Rating Scale

XR

extended release

1.1. Case Identification and Assessment of Adults with Bipolar Disorder

  • Reference to included study:
    • Menzin J, Sussman M, Tafesse E, Duczakowski C, Neumann P, Friedman M. A model of the economic impact of a bipolar disorder screening program in primary care. Journal of Clinical Psychiatry. 2009;70:1230–06. [PubMed: 19689919]

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1.2. Pharmacological Interventions for Mania, Hypomania and Mixed Episodes in Adults with Bipolar Disorder

  • References to included studies:
    1. Bridle C, Palmer S, Bagnall AM, Darba J, Duffy S, Sculpher M, et al. 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 Technology Assessment. 2004;8. [PubMed: 15147609]
    2. Caro JJ, Huybrechts KF, Xenakis JG, O’Brien JA, Rajagopalan K, Lee K. Budgetary impact of treating acute bipolar mania in hospitalized patients with quetiapine: an economic analysis of clinical trials. Current Medical Research and Opinion. 2006;22:2233–42. [PubMed: 17076984]
    3. Revicki DA, Paramore LC, Sommerville KW, Swann AC, Zajecka JM, for the Depakote Comparator Study Group. Divalproex sodium versus olanzapine in the treatment of acute mania in bipolar disorder: health-related quality of life and medical cost outcomes. Journal of Clinical Psychiatry. 2003;64:288–94. [PubMed: 12716270]
    4. Zhu B, Tunis SL, Zhao Z, Baker RW, Lage MJ, Shi L, Tohen M. Service utilization and costs of olanzapine versus divalproex treatment for acute mania: results from a randomized, 47-week clinical trial. Current Medical Research and Opinion. 2005;21:555–64. [PubMed: 15899104]

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1.3. Pharmacological Interventions for Acute Depression in Adults with Bipolar Disorder

  • Reference to included study:
    • Ekman M, Lindgren P, Miltenburger C, Meier G, Locklear JC, Chatterton ML. Cost effectiveness of quetiapine in patients with acute bipolar depression and in maintenance treatment after an acute depressive episode. PharmacoEconomics. 2012;30:513–30. [PubMed: 22591130]

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1.4. Services for Adults with Bipolar Disorder – Mood Disorder Clinics

  • Reference to included study:
    • Kessing LV, Hansen HV, Hvenegaard A, Christensen EM, Dam H, Gluud C, et al. Treatment in a specialised out-patient mood disorder clinic v. standard out-patient treatment in the early course of bipolar disorder: randomised clinical trial. British Journal of Psychiatry. 2013;202:212–9. [PubMed: 23349295]

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1.5. Pharmacological Interventions for the Long-Term Management of Adults with Bipolar Disorder

  • References to included studies:
    1. Calvert NW, Burch SP, Fu AZ, Reeves P, Thompson TR. The cost-effectiveness of lamotrigine in the maintenance treatment of adults with bipolar I disorder. Journal of Managed Care Pharmacy. 2006;12:322–30. [PMC free article: PMC10437984] [PubMed: 16792438]
    2. Ekman M, Lindgren P, Miltenburger C, Meier G, Locklear JC, Chatterton ML. Cost-effectiveness of quetiapine in patients with acute bipolar depression and in maintenance treatment after an acute depressive episode. PharmacoEconomics. 2012;30:513–30. [PubMed: 22591130]
    3. Fajutrao L, Paulsson B, Liu S, Locklear J. Cost-effectiveness of quetiapine plus mood stabilizers compared with mood stabilizers alone in the maintenance therapy of bipolar I disorder: Results of a Markov model analysis. Clinical Therapeutics. 2009;3:1456–68. [PubMed: 19698903]
    4. McKendrick J, Cerri KH, Lloyd A, D’Ausilio A, Dando S, Chinn C. Cost effectiveness of olanzapine in prevention of affective episodes in bipolar disorder in the United Kingdom. Journal of Psychopharmacology. 2007;21:588–96. [PubMed: 17050661]
    5. NCCMH (2006) Bipolar Disorder: the Management of Bipolar Disorder in Adults, Children and Adolescents, in Primary and Secondary Care. Leicester and London: The British Psychological Society and the Royal College of Psychiatrists.
    6. Revicki DA, Hirschfeld RM, Ahearn EP, Weisler RH, Palmer C, Keck PE Jr. Effectiveness and medical costs of divalproex versus lithium in the treatment of bipolar disorder: results of a naturalistic clinical trial. Journal of Affective Disorders. 2005;86:183–93. [PubMed: 15935238]
    7. Soares-Weiser K, Bravo Vergel Y, Beynon S, Dunn G, Barbieri M, Duffy S, et al. A systematic review and economic model of the clinical effectiveness and cost-effectiveness of interventions for preventing relapse in people with bipolar disorder. Health Technology Assessment. 2007;11. [PubMed: 17903393]
    8. Woodward TC, Tafesse E, Quon P, Kim J, Lazarus A. Cost-effectiveness of quetiapine with lithium or divalproex for maintenance treatment of bipolar I disorder. Journal of Medical Economics 2009;12:259–68. [PubMed: 19769548]
    9. Woodward TC, Tafesse E, Quon P, Lazarus A. Cost effectiveness of adjunctive quetiapine fumarate extended-release tablets with mood stabilizers in the maintenance treatment of bipolar I disorder. PharmacoEconomics. 2010;28:751–64. [PubMed: 20623994]

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1.6. Nutritional Interventions for the Long-Term Management of Adults with Bipolar Disorder

  • Reference to included study:
    • Cheema N, Frangou S, McCrone P. Cost-effectiveness of ethyleicosapentaenoic acid in the treatment of bipolar disorder. Therapeutic Advances in Psychopharmacology. 2013;3:73–81. [PMC free article: PMC3805392] [PubMed: 24167678]

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1.7. Psychological and Psychosocial Interventions for Adults with Bipolar Disorder

  • References to included studies:
    1. Lam DH, McCrone P, Wright K, Kerr N. Cost-effectiveness of relapse-prevention cognitive therapy for bipolar disorder: 30-Month study. British Journal of Psychiatry. 2005;186:500–06. [PubMed: 15928361]
    2. Scott J, Colom F, Popova E, Benabarre A, Cruz N, Valenti M, et al. Long-term mental health resource utilization and cost of care following group psychoeducation or unstructured group support for bipolar disorders: a cost-benefit analysis. Journal of Clinical Psychiatry. 2009;70:378–86 [PubMed: 19284929]

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1.8. Pharmacological Interventions for Mania, Hypomania and Mixed Episodes in Children and Young People with Bipolar Disorder

  • Reference to included study:
    • Uttley L, Kearns B, Ren S, Stevenson M. Aripiprazole for the treatment and prevention of acute manic and mixed episodes in bipolar I disorder in children and adolescents: a NICE single technology appraisal. PharmacoEconomics. 2013;31:981–90. [PubMed: 24092620]

Download PDF (136K)

© The British Psychological Society & The Royal College of Psychiatrists, 2014.

All rights reserved. No part of this guideline may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, or in any information storage or retrieval system, without permission in writing from the National Collaborating Centre for Mental Health. Enquiries in this regard should be directed to the Centre Administrator: ku.ca.hcyspcr@nimdAHMCCN

Bookshelf ID: NBK545970
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