Center for eHealth and Well-being Research, Department of Psychology, Health, and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, Netherlands.
Center for Economic Evaluation and Machine Learning, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, Netherlands; Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, Netherlands.
J Affect Disord. 2020 Nov 1;276:388-401. doi: 10.1016/j.jad.2020.06.064. Epub 2020 Jul 15.
Background Bipolar disorder (BD) is associated with substantial societal burden. Therefore, economic studies in BD are becoming increasingly important. The goal of the current study is three-fold: (1) summarize the evidence regarding economic evaluations (EEs) of non-pharmacological interventions for BD, (2) summarize cost-of-illness studies (COIs) for BD published 2012 or later and (3) assess the quality of the identified studies. Methods A systematic search was conducted in MedLine, EMBASE and PsycINFO. For both EEs and COIs, quality assessments were conducted and general and methodological characteristics of the studies were extracted. Outcomes included incremental-cost-effectiveness ratios for EEs and direct and indirect costs for COIs. Results Eight EEs and ten COIs were identified. The included studies revealed high heterogeneity in general and methodological characteristics and study quality. All interventions resulted in improved clinical outcomes. Five studies additionally concluded decreased total costs. For COIs, we found a wide range of direct ($881-$27,617) and indirect cost estimates per capita per year ($1,568-$116,062). Limitations High heterogeneity in terms of interventions, study design and outcomes made it difficult to compare results across studies. Conclusions Interventions improved clinical outcomes in all studies and led to cost-savings in five studies. Findings suggest that non-pharmacological intervention for BD might be cost-effective. Studies on the costs of BD revealed that BD has a substantial economic burden. However, we also found that the number of EEs was relatively low and methodology was heterogenous and therefore encourage future research to widen the body of knowledge in this research field and use standardized methodology.
双相障碍（BD）与巨大的社会负担相关。因此，BD 的经济学研究正变得越来越重要。本研究的目的有三：（1）总结非药物干预 BD 的经济学评价（EE）的证据，（2）总结 2012 年或之后发表的 BD 的疾病成本研究（COI），（3）评估所识别研究的质量。
系统检索了 MedLine、EMBASE 和 PsycINFO。对于 EE 和 COI，都进行了质量评估，并提取了研究的一般和方法学特征。结果包括 EE 的增量成本-效果比和 COI 的直接和间接成本。
共纳入 8 项 EE 和 10 项 COI。纳入研究在一般和方法学特征以及研究质量方面存在高度异质性。所有干预措施都改善了临床结局。五项研究还得出总费用降低的结论。对于 COI，我们发现人均每年的直接成本（$881-$27,617）和间接成本估计值（$1,568-$116,062）范围很广。
干预措施、研究设计和结局方面的高度异质性使得难以在研究之间进行结果比较。
所有研究中的干预措施均改善了临床结局，五项研究中干预措施还导致了成本节约。这些结果表明，BD 的非药物干预可能具有成本效益。BD 成本研究表明，BD 具有巨大的经济负担。然而，我们还发现 EE 的数量相对较少，方法学也存在异质性，因此鼓励未来的研究扩大该研究领域的知识体系，并使用标准化方法。
