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Divalproex and lithium are similarly cost effective for adults with bipolar disorder

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 Q Is divalproex more cost effective than lithium for adults with bipolar disorder?

METHODS

Embedded ImageDesign:

Randomised controlled trial.

Embedded ImageAllocation:

Not clear.

Embedded ImageBlinding:

Unblinded.

Embedded ImageFollow up period:

Twelve months.

Embedded ImageSetting:

Thirty three university and community based psychiatric practices, USA; 1995–97.

Embedded ImagePatients:

221 people 18 years or over with bipolar disorder (DSM-IV) hospitalised for an acute manic or mixed episode. Exclusions: serious neurological abnormalities; seizure disorders; drug or AIDS induced mania; uncontrolled medical comorbidity; taking anticoagulants; breastfeeding or likely to become pregnant.

Embedded ImageIntervention:

Divalproex sodium (15–20 mg/kg/day) or lithium (up to 1800 mg/day in the acute treatment phase; 900–1200 mg/day in the maintenance phase). All participants also received usual psychiatric care.

Embedded ImageOutcomes:

Quality of life (QOL; SF-36 mental and physical component summaries, Mental Health Index-17); months without DSM-IV mania and depression estimated direct medical costs (estimates in 1997 US$).

Embedded ImagePatient follow up:

77.8% at 12 months.

MAIN RESULTS

There were …

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