A multiattribute decision model for bipolar disorder: identification of preferred mood-stabilizing medications

To develop a multiattribute decision model (MADM) to aid in the selection of preferred medications for the treatment of bipolar disorder.

Data were obtained via a self-administered online survey among psychiatric pharmacist specialists. These survey data were used to construct a MADM based on multiattribute utility technology.

Anticonvulsant mood stabilizers, atypical antipsychotics, olanzapine-fluoxetine combination, and lithium carbonate were evaluated using a MADM. Attributes included in the model were effectiveness, safety and tolerability, cost, monitoring burden, and dosing frequency. A survey instrument was developed to score the relative importance of each attribute and the factor scores for each medication. Four iterations of the model were performed to ascertain the medication with the highest total utility score when the effectiveness factors were weighted to consider the following: overall effectiveness, effectiveness in acute mania, effectiveness in acute bipolar depression, and effectiveness in maintenance treatment. Sensitivity analyses were performed to evaluate the stability of the MADM results.

When overall effectiveness, effectiveness in acute mania, or effectiveness in maintenance treatment was considered, lithium carbonate had the highest total utility score. When effectiveness in acute bipolar depression was considered, lamotrigine had the highest total utility score. When considering only atypical antipsychotics, aripiprazole was associated with the highest total utility score for all iterations of the MADM.

The use of a MADM may be a beneficial tool to assist in making formulary or preferred therapeutic agent decisions.