Health-economic implications of the onset of action of antimanic agents.

BACKGROUND

Three medications, lithium, valproate, and carbamazepine, have been shown to be effective in the treatment of acute mania in randomized, controlled clinical trials. Additional research over the past decade has provided data regarding potential differences between these medications according to their time course of onset and clinical predictors of response in acute mania. These differences have potential impact on both the choice of medication and the health-economics of the treatment of acute mania.

METHOD: Published reports regarding the time course of onset, clinical factors associated with response, and health-economic impact of the treatment of acute mania with lithium, valproate, and carbamazepine were reviewed (PAPERCHASE data base, 1966 to present, terms: bipolar disorder, drug treatment, lithium, valproate, and carbamazepine).

RESULTS

Valproate, when administered via an oral loading dosage, may have a more rapid onset of action than lithium and carbamazepine. Preliminary data suggest that specific clinical factors associated with response differ between the three medications. Health-economic studies suggest that treatment of acute mania with valproate may be associated with greater cost savings due to shorter lengths of hospital stay, particularly in patients with mixed mania and rapid cycling. Patients treated with the combination of carbamazepine and lithium also had reduced hospital lengths-of-stay in one study. Lithium may have greater cost savings in patients with classic mania.

CONCLUSION

Preliminary data from studies reviewed suggest that important differences exist between lithium, valproate, and carbamazepine in their time course of onset and factors associated with response in the treatment of patients with acute mania. These differences may also impact the cost savings associated with treatment with these agents.