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Effectiveness and medical costs of divalproex versus lithium in the treatment of bipolar disorder: results of a naturalistic clinical trial.
J Affect Disord. 2005 Jun; 86(2-3):183-93.JA

Abstract

OBJECTIVE

The clinical, quality of life (QOL), and medical cost outcomes of treatment with divalproex were compared with lithium in patients with bipolar I disorder over 1 year.

METHODS

In a pragmatic, randomized clinical trial, 201 adults hospitalized with bipolar I manic or mixed episodes were randomized to divalproex or lithium, in addition to usual psychiatric care, and followed for 1 year. All subsequent treatment of bipolar disorder was managed by the patient's psychiatrist. Symptoms of mania and depression were evaluated at baseline and at hospital discharge. Assessments at the start of maintenance therapy and after 1, 3, 6, 9 and 12 months included manic and depressive symptoms, disability days and QOL. Medical resource use data were also collected monthly and costs were estimated using national sources.

RESULTS

Divalproex-treated patients (12%) were less likely to discontinue study medications for lack of efficacy or adverse effects than lithium-treated patients (23%). No statistically significant differences between the treatment groups were observed over the 1-year maintenance phase for clinical symptoms, QOL outcomes, or disability days. Mean estimated total medical costs were USD 28,911 for the divalproex group compared with USD 30,666 for the lithium treatment group. Patients continuing mood stabilizer therapy at 3 months had slightly better health outcomes and substantially lower total medical costs than those who discontinued therapy (USD 10,091 versus USD 34,432, respectively).

CONCLUSIONS

Divalproex maintenance treatment for bipolar disorder resulted in comparable medical costs, clinical and QOL outcomes compared with lithium. Patients remaining on mood stabilizer therapy had substantially lower total medical costs and better health outcomes compared with those who discontinued therapy.

Authors+Show Affiliations

Center for Health Outcomes Research, MEDTAP International, 7101 Wisconsin Avenue, Suite 600, Bethesda, MD 20814, USA. Revicki@Medtap.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15935238

Citation

Revicki, Dennis A., et al. "Effectiveness and Medical Costs of Divalproex Versus Lithium in the Treatment of Bipolar Disorder: Results of a Naturalistic Clinical Trial." Journal of Affective Disorders, vol. 86, no. 2-3, 2005, pp. 183-93.
Revicki DA, Hirschfeld RM, Ahearn EP, et al. Effectiveness and medical costs of divalproex versus lithium in the treatment of bipolar disorder: results of a naturalistic clinical trial. J Affect Disord. 2005;86(2-3):183-93.
Revicki, D. A., Hirschfeld, R. M., Ahearn, E. P., Weisler, R. H., Palmer, C., & Keck, P. E. (2005). Effectiveness and medical costs of divalproex versus lithium in the treatment of bipolar disorder: results of a naturalistic clinical trial. Journal of Affective Disorders, 86(2-3), 183-93.
Revicki DA, et al. Effectiveness and Medical Costs of Divalproex Versus Lithium in the Treatment of Bipolar Disorder: Results of a Naturalistic Clinical Trial. J Affect Disord. 2005;86(2-3):183-93. PubMed PMID: 15935238.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effectiveness and medical costs of divalproex versus lithium in the treatment of bipolar disorder: results of a naturalistic clinical trial. AU - Revicki,Dennis A, AU - Hirschfeld,Robert M A, AU - Ahearn,Eileen P, AU - Weisler,Richard H, AU - Palmer,Cynthia, AU - Keck,Paul E,Jr PY - 2003/09/24/received PY - 2005/01/12/accepted PY - 2005/6/7/pubmed PY - 2005/9/24/medline PY - 2005/6/7/entrez SP - 183 EP - 93 JF - Journal of affective disorders JO - J Affect Disord VL - 86 IS - 2-3 N2 - OBJECTIVE: The clinical, quality of life (QOL), and medical cost outcomes of treatment with divalproex were compared with lithium in patients with bipolar I disorder over 1 year. METHODS: In a pragmatic, randomized clinical trial, 201 adults hospitalized with bipolar I manic or mixed episodes were randomized to divalproex or lithium, in addition to usual psychiatric care, and followed for 1 year. All subsequent treatment of bipolar disorder was managed by the patient's psychiatrist. Symptoms of mania and depression were evaluated at baseline and at hospital discharge. Assessments at the start of maintenance therapy and after 1, 3, 6, 9 and 12 months included manic and depressive symptoms, disability days and QOL. Medical resource use data were also collected monthly and costs were estimated using national sources. RESULTS: Divalproex-treated patients (12%) were less likely to discontinue study medications for lack of efficacy or adverse effects than lithium-treated patients (23%). No statistically significant differences between the treatment groups were observed over the 1-year maintenance phase for clinical symptoms, QOL outcomes, or disability days. Mean estimated total medical costs were USD 28,911 for the divalproex group compared with USD 30,666 for the lithium treatment group. Patients continuing mood stabilizer therapy at 3 months had slightly better health outcomes and substantially lower total medical costs than those who discontinued therapy (USD 10,091 versus USD 34,432, respectively). CONCLUSIONS: Divalproex maintenance treatment for bipolar disorder resulted in comparable medical costs, clinical and QOL outcomes compared with lithium. Patients remaining on mood stabilizer therapy had substantially lower total medical costs and better health outcomes compared with those who discontinued therapy. SN - 0165-0327 UR - https://www.unboundmedicine.com/medline/citation/15935238/Effectiveness_and_medical_costs_of_divalproex_versus_lithium_in_the_treatment_of_bipolar_disorder:_results_of_a_naturalistic_clinical_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0165-0327(05)00008-X DB - PRIME DP - Unbound Medicine ER -