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Cost Effectiveness of Quetiapine in Patients with Acute Bipolar Depression and in Maintenance Treatment after an Acute Depressive Episode

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Abstract

Background

Bipolar disorder has a significant impact upon a patient’s quality of life, imposing a considerable economic burden on the individual, family members and society as a whole. Several medications are indicated for the acute treatment of mania and depression associated with bipolar disorder as well as for maintenance therapy; however, these have varying efficacy, tolerability and costs.

Objective

The objective of this study was to develop a new discrete-event simulation model to analyse the long-term consequences of pharmacological therapy for the management of bipolar I and II disorders (acute treatment of episodes of mania and depression as well as maintenance therapy).

Methods

Probabilities of remission and relapse were obtained from clinical trial data and meta-analyses. Costs (year 2011 values) were assessed from a UK healthcare payer’s perspective, and included pharmacological therapy and resource use associated with the treatment of mood events and selected adverse events. The health effects were measured in terms of QALYs.

Results

For a patient starting with acute depression or in remission at 40 years of age (which was the average age in the clinical trials), quetiapine 300 mg/day was a cost-effective strategy compared with olanzapine 15 mg/day over a 5-year time frame. With acute bipolar depression as a starting episode, the 5-year medical costs were £323 higher and QALYs were 0.038 higher for quetiapine compared with olanzapine, corresponding to a cost-effectiveness ratio of £8600 per QALY gained.

Conclusion

Compared with olanzapine, the results suggest that quetiapine is cost effective as a maintenance treatment for bipolar depression.

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Acknowledgements

The study was supported by funding from AstraZeneca Pharmaceuticals LP, the manufacturer of quetiapine, which is gratefully acknowledged. Editorial support, funded by AstraZeneca Pharmaceuticals LP, was provided by PAREXEL.

ME was employed by OptumInsight at the time the study was conducted but is now employed by AstraZeneca Nordic. CM was employed by OptumInsight (formerly i3 Innovus) at the time the study was conducted but is now employed by Medtronic International. GM was employed by AstraZeneca UK Ltd when the study was conducted but is now an employee of GlaxoSmithKline. OptumInsight, a contract research organization in health economic and outcomes research, received payments from AstraZeneca to conduct work on the manuscript. MLC was a consultant to AstraZeneca while conducting this study.

ME was the principal author of the study. ME, CM, JCL and MLC contributed to the study concept and design with input from the co-authors. Data collection was the work of ME, with input from CM, GM, JCL and MLC. Drafting the manuscript and its revision were primarily the work of ME, PL and CM, with input from the co-authors and assistance with editing from PAREXEL.

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Authors and Affiliations

  1. OptumInsight, Stockholm, Sweden

    Mattias Ekman & Peter Lindgren

  2. OptumInsight, Berlin, Germany

    Carolin Miltenburger

  3. AstraZeneca UK Ltd, Luton, UK

    Genevieve Meier

  4. AstraZeneca Pharmaceuticals LP, Wilmington, Delaware, USA

    Julie C. Locklear

  5. MLG Consulting Services, Inc., Wilmington, Delaware, USA

    Mary Lou Chatterton

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  1. Mattias Ekman
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  2. Peter Lindgren
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Correspondence to Mattias Ekman.

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Ekman, M., Lindgren, P., Miltenburger, C. et al. Cost Effectiveness of Quetiapine in Patients with Acute Bipolar Depression and in Maintenance Treatment after an Acute Depressive Episode. PharmacoEconomics 30, 513–530 (2012). https://doi.org/10.2165/11594930-000000000-00000

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