Abdul Pari Anees Ahmed, Simon Judit, Wolstenholme Jane, Geddes John R, Goodwin Guy M
Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Bipolar Disord. 2014 Sep;16(6):557-82. doi: 10.1111/bdi.12213. Epub 2014 Jun 11.
Bipolar disorder (BD) is a chronic illness and is one of the worldwide leading causes of disability. It is often a lifelong illness and incurs a substantial economic burden on the health care system, the patients, and society as a whole. However, there are few studies evaluating the economic impact of alternative strategies in the management of BD.
We reviewed and critically appraised the available published economic evidence on BD management. In addition, we explored advantages and disadvantages of different methods used in the economic evaluation of the management of BD.
A systematic literature search was undertaken using seven electronic databases to identify all English language articles published between January 1980 and March 2012 that provided data on complete economic evaluations for any treatment strategy for BD. The quality of included studies was appraised according to recommendations from the Cochrane Collaboration.
A total of 7,284 citations were obtained. After initial screening, 20 eligible studies were identified, five of which were trial-based, and 15 of which were model-based economic evaluations. Given the variability in methods and the quality of the identified studies, no conclusive recommendation for the most cost-effective therapy for BD could be provided.
The cost-effectiveness of different treatment strategies varied between settings, and transferability of these results across settings remains questionable. Although additional research using a longer time horizon is required to validate the findings for trial-based economic evaluations, discrete event simulation appears to be the most natural and plausible technique for modeling the cost-effectiveness of alternative BD treatment strategies.
双相情感障碍（BD）是一种慢性疾病，是全球导致残疾的主要原因之一。它通常是一种终身疾病，给医疗保健系统、患者及整个社会带来巨大的经济负担。然而，很少有研究评估双相情感障碍管理中替代策略的经济影响。
我们回顾并批判性地评价了双相情感障碍管理方面已发表的现有经济证据。此外，我们探讨了双相情感障碍管理经济评估中使用的不同方法的优缺点。
使用七个电子数据库进行系统的文献检索，以识别1980年1月至2012年3月期间发表的所有英文文章，这些文章提供了双相情感障碍任何治疗策略的完整经济评估数据。根据Cochrane协作网的建议对纳入研究的质量进行评估。
共获得7284条引文。初步筛选后，确定了20项符合条件的研究，其中5项基于试验，15项基于模型的经济评估。鉴于所确定研究的方法和质量存在差异，无法为双相情感障碍最具成本效益的治疗提供确凿建议。
不同治疗策略的成本效益因环境而异，这些结果在不同环境中的可转移性仍值得怀疑。虽然需要使用更长时间跨度的额外研究来验证基于试验的经济评估结果，但离散事件模拟似乎是模拟双相情感障碍替代治疗策略成本效益的最自然和合理的技术。
