The British Journal of Psychiatry


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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