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Cost Effectiveness of Adjunctive Quetiapine Fumarate Extended-Release Tablets with Mood Stabilizers in the Maintenance Treatment of Bipolar I Disorder

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Abstract

Background: Bipolar I disorder (BPD I) is a recurrent illness that affects 1%of the US population and constitutes a large economic burden. However, few studies have investigated the cost effectiveness of maintenance treatment options for BPD I.

Objective: To determine the cost effectiveness of maintenance treatment with quetiapine fumarate extended-release (XR) tablets in combination with mood stabilizers (lithium or divalproex) in comparison with the following treatments: placebo in combination with lithium or divalproex; no maintenance treatment; lithium monotherapy; lamotrigine monotherapy; olanzapine monotherapy; and aripiprazole monotherapy.

Methods: The analysis was conducted from the societal and payer perspectives in the US, using a Markov model. The model simulated a cohort of 1000 stabilized BPD I patients and estimated the quarterly risk in three health states: euthymia, mania and depression. Efficacy data were derived from two randomized, double-blind trials comparing quetiapine + lithium/divalproex with placebo + lithium/divalproex for up to 2 years, as well as other published literature. Resource data were extracted from published literature. Drug costs, hospitalizations and physician visits were among the direct costs. Indirect costs included absenteeism, and mortality rates included suicide. Benefits and costs were discounted at 3% and the price reference year was 2009. Endpoints included number of acute mood episodes, hospitalizations due to an acute mood event and costs per QALY. Probabilistic sensitivity analysis (PSA) was conducted to evaluate uncertainty in the model inputs.

Results: Treatment with quetiapine XR+ lithium/divalproex was associated with reductions in acute mania (46%), acute depression (41%) and related hospitalizations (44%) compared with placebo + lithium/divalproex, and similar reductions in events were observed relative to lithium monotherapy. In the base-case analysis from the payer perspective, the discounted incremental cost per QALY for quetiapine XR+ lithium/divalproex compared with placebo + lithium/divalproex was $US22 959, and compared with lithium monotherapy was $US100 235, while all other comparators were dominated. PSA showed these results to be robust to select assumptions. Conclusions: Quetiapine XR+ lithium/divalproex may be a cost-effective maintenance treatment option for patients with BPD I.

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References

  1. American Psychiatric Association. Practice guideline for the treatment of patients with bipolar disorder (revision). Am J Psychiatry 2002 Apr; 159 (4 Suppl.): 1–50

    Google Scholar 

  2. Merikangas KR, Akiskal HS, Angst J, et al. Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication. Arch Gen Psychiatry 2007 May; 64 (5): 543–52

    Article  PubMed  Google Scholar 

  3. Revicki DA, Matza LS, Flood E, et al. Bipolar disorder and health-related quality of life: review of burden of disease and clinical trials. Pharmacoeconomics 2005; 23 (6): 583–94

    Article  PubMed  Google Scholar 

  4. Sharma R, Markar HR. Mortality in affective disorder. J Affect Disord 1994 Jun; 31 (2): 91–6

    Article  PubMed  CAS  Google Scholar 

  5. Kleinman L, Lowin A, Flood E, et al. Costs of bipolar disorder. Pharmacoeconomics 2003; 21 (9): 601–22

    Article  PubMed  Google Scholar 

  6. Begley CE, Annegers JF, Swann AC, et al. The lifetime cost of bipolar disorder in the US: an estimate for new cases in 1998. Pharmacoeconomics 2001; 19 (5 Pt 1): 483–95

    Article  PubMed  CAS  Google Scholar 

  7. Wyatt RJ, Henter I. An economic evaluation of manicdepressive illness: 1991. Soc Psychiatry Psychiatr Epidemiol 1995 Aug; 30 (5): 213–9

    PubMed  CAS  Google Scholar 

  8. McIntyre RS, Woldeyohannes HO, Yasgur BS, et al. Maintenance treatment in bipolar disorder: a focus on aripiprazole. Expert Rev Neurother 2007 Aug; 7 (8): 919–25

    Article  PubMed  CAS  Google Scholar 

  9. Suppes T, Vieta E, Liu S, et al., Trial 127 investigators. Maintenance treatment for patients with bipolar I disorder: results from a North American study of quetiapine in combination with lithium or divalproex (trial 127). Am J Psychiatry 2009 Apr; 166 (4): 476–88

    Google Scholar 

  10. Vieta E, Suppes T, Eggens I, et al. Efficacy and safety of quetiapine in combination with lithium or divalproex for maintenance of patients with bipolar I disorder (International Trial 126). J Affect Disord 2008 Aug; 109 (3): 251–63

    Article  PubMed  CAS  Google Scholar 

  11. Figueroa C, Brecher M, Hamer-Maansson JE, et al. Pharmacokinetic profiles of extended release quetiapine fumarate compared with quetiapine immediate release. Prog Neuropsychopharmacol Biol Psychiatry 2009 Mar 17; 33 (2): 199–204

    Article  PubMed  CAS  Google Scholar 

  12. Calvert NW, Burch SP, Fu AZ, et al. The cost-effectiveness of lamotrigine in the maintenance treatment of adults with bipolar I disorder. J Manag Care Pharm 2006 May; 12 (4): 322–30

    PubMed  Google Scholar 

  13. Bowden CL, Calabrese JR, Sachs G, et al.Aplacebo-controlled 18-month trial of lamotrigine and lithium maintenance treatment in recently manic or hypomanic patients with bipolar I disorder. Arch Gen Psychiatry 2003 Apr; 60 (4): 392–400

    Article  PubMed  CAS  Google Scholar 

  14. Prescribing information: Seroquel XR. Wilmington (DE): AstraZeneca Pharmaceuticals LP [online]. Available from URL: http://www1.astrazeneca-us.com/pi/seroquelxr.pdf [Accessed 2009 Oct 1]

  15. Tohen M, Calabrese JR, Sachs GS, et al. Randomized, placebo-controlled trial of olanzapine as maintenance therapy in patients with bipolar I disorder responding to acute treatment with olanzapine. Am J Psychiatry 2006 Feb; 163 (2): 247–56

    Article  PubMed  Google Scholar 

  16. Keck Jr PE, Calabrese JR, McQuade RD, et al. A randomized, double-blind, placebo-controlled 26-week trial of aripiprazole in recently manic patients with bipolar I disorder. J Clin Psychiatry 2006 Apr; 67 (4): 626–37

    Article  PubMed  CAS  Google Scholar 

  17. US Department of Health and Human Services; Centers for Disease Control and Prevention. Deaths: final data for 2004. Natl Vital Stat Rep 2007 Aug 21; 55 (19) [online]. Available from URL: http://www.cdc.gov/nchs/data/nvsr/nvsr55/nvsr55_19.pdf [Accessed 2010 Jun 3]

  18. Simon GE, Hunkeler E, Fireman B, et al. Risk of suicide attempt and suicide death in patients treated for bipolar disorder. Bipolar Disord 2007 Aug; 9 (5): 526–30

    Article  PubMed  Google Scholar 

  19. Fleurence RL, Hollenbeak CS. Rates and probabilities in economic modelling: transformation, translation and appropriate application. Pharmacoeconomics 2007; 25 (1):3–6

    Article  PubMed  Google Scholar 

  20. Calabrese JR, Bowden CL, Sachs G, et al. A placebocontrolled 18-month trial of lamotrigine and lithium maintenance treatment in recently depressed patients with bipolar I disorder. J Clin Psychiatry 2003 Sep; 64 (9): 1013–24

    Article  PubMed  CAS  Google Scholar 

  21. Brazier J, Roberts J, Deverill M. The estimation of a preference-based measure of health from the SF-36. J Health Econ 2002 Mar; 21 (2): 271–92

    Article  PubMed  Google Scholar 

  22. Red Book™ for Windows®. Version 61127. Montvale (NJ): Thomson Reuters, 2009

  23. Kessler RC, Akiskal HS, Ames M, et al. Prevalence and effects of mood disorders on work performance in a nationally representative sample of US workers. Am J Psychiatry 2006 Sep; 163 (9): 1561–8

    Article  PubMed  Google Scholar 

  24. US Department of Labor, Bureau of Labor Statistics. Consumer price indexes [online]. Available from URL: http://www.bls.gov/cpi/ [Accessed 2007 Oct 10]

    Google Scholar 

  25. Hirth RA, Chernew ME, Miller E, et al. Willingness to pay for a quality-adjusted life year: in search of a standard. Med Decis Making 2000 Jul; 20 (3): 332–42

    Article  PubMed  CAS  Google Scholar 

  26. Fleurence RL, Chatterton ML, Dixon JM, et al. Economic outcomes associated with atypical antipsychotics in bipolar disorder: a systematic review. Prim Care Companion J Clin Psychiatry 2007; 9 (6): 419–28

    Article  PubMed  Google Scholar 

  27. Soares-Weiser K, Bravo Vergel Y, Beynon S, et al. A systematic review and economic model of the clinical effectivenes and cost-effectiveness of interventions for preventing relapse in people with bipolar disorder. Health Technol Assess 2007; 11 (39): iii-iv, ix–206

    Google Scholar 

  28. McKendrick J, Cerri KH, Lloyd A, et al. Cost effectiveness of olanzapine in prevention of affective episodes in bipolar disorder in the United Kingdom. J Psychopharmacol 2007 Aug; 21 (6): 588–96

    Article  PubMed  CAS  Google Scholar 

  29. Kupfer DJ, Frank E, Grochocinski VJ, et al. Stabilization in the treatment of mania, depression and mixed states. Acta Neuropsychiatr 2000; 12: 110–4

    Google Scholar 

  30. Kessing LV, Munk-Jorgensen P. Does type of first contact in depressive and bipolar disorders predict subsequent hospitalisation and risk of suicide? J Affect Disord 2004 Nov 15; 83 (1): 65–71

    Article  PubMed  Google Scholar 

  31. Gonzalez-Pinto AM, Dardennes R, de Zélicourt M, et al. Inpatient care costs of patients with bipolar I disorder: a comparison between two European centers. J Affect Disord 2010 Nov; 121 (1-2): 152–5

    Article  PubMed  CAS  Google Scholar 

  32. Revicki DA, Wood M. Patient-assigned health state utilities for depression-related outcomes: differences by depression severity and antidepressant medications. J Affect Disord 1998 Feb; 48 (1): 25–36

    Article  PubMed  CAS  Google Scholar 

  33. McIntyre RS, Konarski JZ. Tolerability profiles of atypical antipsychotics in the treatment of bipolar disorder. J Clin Psychiatry 2005; 66 Suppl. 3: 28–36

    PubMed  CAS  Google Scholar 

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Acknowledgements

This study was supported by a research grant from AstraZeneca Pharmaceuticals LP, Wilmington, Delaware, USA. The authors would like to acknowledge the editorial assistance of Eleanor Bull, PhD (PAREXEL). Financial support for this assistance was provided by AstraZeneca Pharmaceuticals LP.

Tatia Woodward and Peter Quon are consultants for United BioSource Corporation and have consulted for numerous pharmaceutical companies, including AstraZeneca Pharmaceuticals LP. Eskinder Tafesse and Arthur Lazarus are employed by AstraZeneca Pharmaceuticals LP and are eligible to receive stock options.

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Authors and Affiliations

  1. United Biosource Corporation, Bethesda, Maryland, USA

    Tatia Chay Woodward & Peter Quon

  2. AstraZeneca Pharmaceuticals LP, 1800 Concord Pike, Wilmington, Delaware, 19850, USA

    Eskinder Tafesse & Arthur Lazarus

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  1. Tatia Chay Woodward
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  2. Eskinder Tafesse
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  3. Peter Quon
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Correspondence to Eskinder Tafesse.

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Woodward, T.C., Tafesse, E., Quon, P. et al. Cost Effectiveness of Adjunctive Quetiapine Fumarate Extended-Release Tablets with Mood Stabilizers in the Maintenance Treatment of Bipolar I Disorder. Pharmacoeconomics 28, 751–764 (2010). https://doi.org/10.2165/11538350-000000000-00000

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