Cognitive therapy a useful and cost-effective addition in bipolar disorder

Adding cognitive therapy to standard treatment for bipolar disorder led to significantly improved clinical outcomes at no extra overall cost in a recent UK study.The study included 103 adult patients with DSM-IV bipolar I disorder who experienced frequent relapses despite treatment with mood stabilisers.Patients were randomly allocated to receive cognitive therapy in addition to standard treatment with mood stabilisers (n=51) or standard treatment alone (n=52).The primary clinical outcome of the study was number of days with bipolar episodes, measured using the Structured Clinical Instrument for DSM-IV (SCID).Patients' specific health and social care use were assessed at baseline and at three-monthly follow-up visits. Service costs per patient were generated by multiplying unit costs by service utilisation data.The number of days with bipolar episodes was significantly lower in the cognitive therapy group compared with the standard treatment group: 62.3 fewer days over the first year and 110 fewer days over the study period as a whole (30 months).These differences remained significant after controlling for number of previous bipolar episodes and medication compliance.In addition, actuarial cumulative relapse rates were lower in the cognitive therapy group compared with the standard treatment group (64% versus 84%) even after controlling for number of previous bipolar episodes and medication compliance.The cost of cognitive therapy was offset by fewer costs for other services.An analysis of cost-effectiveness showed that even if no value is placed on a day free of bipolar symptoms, the probability of cognitive therapy being cost-effective is over 80% during 12 months and 30 months.The probability of cognitive therapy being cost-effective remained high even if the cost was increased by 50%.The study authors conclude that their findings support the addition of cognitive therapy for relapse prevention in bipolar disorder, particularly in those who are vulnerable to relapse despite treatment with mood stabilisers.They add that future research should determine whether users, family members and clinicians view bipolar-free days as a clinically meaningful outcome measure, and if so, exactly how they might be valued.Reference...