NICE has just published a new technology appraisal recommending aripiprazole as a treatment for bipolar disorder in young people.

Technology Appraisals are systematic evaluations of the effectiveness of health technologies.  They do not have the broad scope of guidelines, which focus on topics rather than technologies, but they do give guidance for clinical practice on the effectiveness of specific interventions.

Bottom line

Aripiprazole is recommended as an option for treating moderate to severe manic episodes in adolescents with bipolar I disorder, within its marketing authorisation (that is, up to 12 weeks of treatment for moderate to severe manic episodes in bipolar I disorder in adolescents aged 13 and older).

However, the evidence underlying this recommendation did not contain direct comparisons between alternative drug treatments.  Here in the Woodland, we’d be surprised if this is the final word on this topic.

Coverage

Aripiprazole is an antipsychotic with partial dopamine D2 and D3 agonistic properties.  In the evidence submitted to TA 292, it was compared with risperidone, quetiapine and olanzapine

.The TA is split into the following sections:

Comments

• The literature search was updated in January 2013.
• Most of the clinical evidence for the TA come from a network meta-analysis of RCTs that compared aripiprazole with placebo, and not directly with alternative treatments.  This is a serious limitation.
• In the cost-utility analysis, utility values for quality of life were derived from adult populations.
• The evidence review committee seemed to agree that there were important weaknesses in the submission,  They were not able to make a recommendation about the optimal position of aripiprazole in the treatment pathway.
• However, the economic model showed dominance for all combinations that used aripiprazole compared with alternative treatment combinations.  That is, including aripipratzole led to better outcomes AND lower costs compared with the alternative.
• On this basis, the NICE committee agreed that the drug should be recommended.
• It seems likely that further studies will add precision and clarity to this picture.

Readers who may wish to conduct a format appraisal of this guideline can do so on the AGREE Trust website, using the AGREE II instrument for appraising clinical practice guidelines.

Reference

National Institute for Health and Care Excellence (2013).  Aripiprazole for treating moderate to severe manic episodes in adolescents with bipolar I disorder.  TA 292.