Psychological Medicine



Original Article

Incremental cost-effectiveness of a collaborative care intervention for panic disorder


WAYNE KATON a1c1, JOAN RUSSO a1, CATHY SHERBOURNE a2, MURRAY B. STEIN a3, MICHELLE CRASKE a4, MING-YU FAN a1 and PETER ROY-BYRNE a1
a1 Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
a2 RAND Corporation, Santa Monica, CA, USA
a3 Department of Psychiatry, University of California at San Diego, San Diego, CA, USA
a4 Department of Psychology, University of California at Los Angeles, Los Angeles, CA, USA

Article author query
katon w   [PubMed][Google Scholar] 
russo j   [PubMed][Google Scholar] 
sherbourne c   [PubMed][Google Scholar] 
b. stein m   [PubMed][Google Scholar] 
craske m   [PubMed][Google Scholar] 
fan my   [PubMed][Google Scholar] 
roy-byrne p   [PubMed][Google Scholar] 

Abstract

Background. Panic disorder is a prevalent, often disabling, disorder among primary-care patients, but there are large gaps in quality of treatment in primary care. This study describes the incremental cost-effectiveness of a combined cognitive behavioral therapy (CBT) and pharmacotherapy intervention for patients with panic disorder versus usual primary-care treatment.

Method. This randomized control trial recruited 232 primary-care patients meeting DSM-IV criteria for panic disorder from March 2000 to March 2002 from six primary-care clinics from university-affiliated clinics at the University of Washington (Seattle) and University of California (Los Angeles and San Diego). Patients were randomly assigned to receive either treatment as usual or a combined CBT and pharmacotherapy intervention for panic disorder delivered in primary care by a mental health therapist. Intervention patients had up to six sessions of CBT modified for the primary-care setting in the first 12 weeks, and up to six telephone follow-ups over the next 9 months. The primary outcome variables were total out-patient costs, anxiety-free days (AFDs) and quality adjusted life-years (QALYs).

Results. Relative to usual care, intervention patients experienced 60·4 [95% confidence interval (CI) 42·9–77·9] more AFDs over a 12-month period. Total incremental out-patient costs were $492 higher (95% CI $236–747) in intervention versus usual care patients with a cost per additional AFD of $8.40 (95% CI $2.80–14.0) and a cost per QALY ranging from $14158 (95% CI $6791–21496) to $24776 (95% CI $11885–37618). The cost per QALY estimate is well within the range of other commonly accepted medical interventions such as statin use and treatment of hypertension.

Conclusions. The combined CBT and pharmacotherapy intervention was associated with a robust clinical improvement compared to usual care with a moderate increase in ambulatory costs.

(Published Online January 10 2006)


Correspondence:
c1 Department of Psychiatry and Behavioral Sciences, Box 356560, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195-6560, USA. (Email: wkaton@u.washington.edu)


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