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The British Journal of Psychiatry (2005) 187: 559-567
© 2005 The Royal College of Psychiatrists

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

Dan Chisholm, PhD

Department of Health System Financing, and Department of Mental Health and Substance Abuse

Mark van Ommeren, PhD

Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland

Jose-Luis Ayuso-Mateos, MD

Department of Psychiatry, Hospital Universitario de la Princesa, Universidad Autonoma de Madrid, Spain

Shekhar Saxena, MD

Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland

Correspondence: Dr Dan Chisholm, Department of Health System Financing, Evidence and Information for Policy (EIP), World Health Organization, 1211 Geneva, Switzerland. E-mail: ChisholmD{at}who.int

Declaration of interest None.

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 for14 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 mostcost-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.


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