Cost-effectiveness of psychological and pharmacological interventions for generalized anxiety disorder and panic disorder.
OBJECTIVE
To assess from a health sector perspective the incremental cost-effectiveness of interventions for generalized anxiety disorder (cognitive behavioural therapy [CBT] and serotonin and noradrenaline reuptake inhibitors [SNRIs]) and panic disorder (CBT, selective serotonin reuptake inhibitors [SSRIs] and tricyclic antidepressants [TCAs]).


METHODS
The health benefit is measured as a reduction in disability-adjusted life years (DALYs), based on effect size calculations from meta-analyses of randomised controlled trials. An assessment on second stage filter criteria ("equity", "strength of evidence", "feasibility" and "acceptability to stakeholders") is also undertaken to incorporate additional factors that impact on resource allocation decisions. Costs and benefits are calculated for a period of one year for the eligible population (prevalent cases of generalized anxiety disorder/panic disorder identified in the National Survey of Mental Health and Wellbeing, extrapolated to the Australian population in the year 2000 for those aged 18 years and older). Simulation modelling techniques are used to present 95% uncertainty intervals (UI) around the incremental cost-effectiveness ratios (ICERs).


RESULTS
Compared to current practice, CBT by a psychologist on a public salary is the most cost-effective intervention for both generalized anxiety disorder (A$6900/DALY saved; 95% UI A$4000 to A$12 000) and panic disorder (A$6800/DALY saved; 95% UI A$2900 to A$15 000). Cognitive behavioural therapy results in a greater total health benefit than the drug interventions for both anxiety disorders, although equity and feasibility concerns for CBT interventions are also greater.


CONCLUSIONS
Cognitive behavioural therapy is the most effective and cost-effective intervention for generalized anxiety disorder and panic disorder. However, its implementation would require policy change to enable more widespread access to a sufficient number of trained therapists for the treatment of anxiety disorders.
Heuzenroeder
Louise
L
Health Surveillance and Evaluation Section, Public Health, Department of Human Services, Melbourne, Australia.
Donnelly
Marie
M
Haby
Michelle M
MM
Mihalopoulos
Cathrine
C
Rossell
Ruth
R
Carter
Rob
R
Andrews
Gavin
G
Vos
Theo
T
D000929:Antidepressive Agents, Tricyclic / Q000191:economics* / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000188:drug therapy / Q000191:economics* / Q000628:therapy*; D001315:Australia; D003362:Cost-Benefit Analysis; D003511:Cyclohexanols / Q000191:economics* / Q000627:therapeutic use; D004185:Disability Evaluation; D006801:Humans; D007099:Imipramine / Q000191:economics* / Q000627:therapeutic use; D008605:Mental Health Services / Q000191:economics*; D016584:Panic Disorder / Q000188:drug therapy / Q000191:economics* / Q000628:therapy*; D017374:Paroxetine / Q000191:economics* / Q000627:therapeutic use; D011613:Psychotherapy / Q000191:economics*; D017367:Selective Serotonin Reuptake Inhibitors / Q000191:economics* / Q000627:therapeutic use; D013997:Time Factors; D000069470:Venlafaxine Hydrochloride
D000929:Antidepressive Agents, Tricyclic; D003511:Cyclohexanols; D007099:Imipramine; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors; D000069470:Venlafaxine Hydrochloride