The cost-effectiveness of psychotherapy and paroxetine for severe irritable bowel syndrome.
OBJECTIVE
Psychotherapy and antidepressants are effective in patients with severe irritable bowel syndrome (IBS), but the cost-effectiveness of either treatment in routine practice has not been established.


METHODS
Patients with severe IBS were randomly allocated to receive 8 sessions of individual psychotherapy, 20 mg daily of the specific serotonin reuptake inhibitor (SSRI) antidepressant, paroxetine, or routine care by a gastroenterologist and general practitioner. Primary outcome measures of abdominal pain, health-related quality of life, and health care costs were determined after 3 months of treatment and 1 year later.


RESULTS
A total of 257 subjects (81% response rate) from 7 hospitals were recruited; 59 of 85 patients (69%) randomized to psychotherapy and 43 of 86 (50%) of the paroxetine group completed the full course of treatment. Both psychotherapy and paroxetine were superior to treatment as usual in improving the physical aspects of health-related quality of life (SF-36 physical component score improvement, 5.2 [SEM, 1.26], 5.8 [SEM, 1.0], and -0.3 [SEM, 1.17]; P < 0.001), but there was no difference in the psychological component. During the follow-up year, psychotherapy but not paroxetine was associated with a significant reduction in health care costs compared with treatment as usual (psychotherapy, $976 [SD, $984]; paroxetine, $1252 [SD, $1616]; and treatment as usual, $1663 [SD, $3177]).


CONCLUSIONS
For patients with severe IBS, both psychotherapy and paroxetine improve health-related quality of life at no additional cost.
Creed
Francis
F
School of Psychiatry and Behavioural Science, University of Manchester, England. francis.creed@man.ac.uk
Fernandes
Lakshmi
L
Guthrie
Elspeth
E
Palmer
Stephen
S
Ratcliffe
Joy
J
Read
Nicholas
N
Rigby
Christine
C
Thompson
David
D
Tomenson
Barbara
B
D000041:Absenteeism; D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D003109:Colonic Diseases, Functional / Q000503:physiopathology* / Q000628:therapy*; D003362:Cost-Benefit Analysis; D005260:Female; D005544:Forecasting; D017048:Health Care Costs; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010146:Pain / Q000503:physiopathology; D017374:Paroxetine / Q000191:economics* / Q000627:therapeutic use*; D010349:Patient Compliance; D011613:Psychotherapy / Q000191:economics*; D011788:Quality of Life; D012720:Severity of Illness Index; D016896:Treatment Outcome
D018687:Antidepressive Agents, Second-Generation; D017374:Paroxetine