Cost-efficacy of individual and combined treatments for panic disorder.
OBJECTIVE
The objective of this study was to examine the relative cost-efficacy of empirically supported treatments for panic disorder. As psychosocial, pharmacologic, and combined treatments have all demonstrated efficacy in the treatment of panic disorder, cost-efficacy analysis provides an additional source of information to guide clinical decision making.


METHODS
Cost-efficacy was examined based on results from the Multicenter Comparative Treatment Study of Panic Disorder, a randomized controlled trial of treatment for panic disorder (DSM-III-R). The trial was conducted from May 1991 to April 1998. Cost-efficacy ratios representing the cost per 1-unit improvement in Panic Disorder Severity Scale mean item score were calculated for 3 monotherapies (cognitive-behavioral therapy [CBT], imipramine, and paroxetine) and 2 combination treatments (CBT-imipramine and CBT-paroxetine) at the end of acute, maintenance, and follow-up phases.


RESULTS
Results demonstrated consistently greater cost-efficacy for individual over combined treatments, with imipramine representing the most cost-efficacious treatment option at the completion of the acute phase (cost-efficacy ratio = $972) and CBT representing the most cost-efficacious option at the end of maintenance treatment (cost efficacy ratio = $1449) and 6 months after treatment termination (cost-efficacy ratio = $1227).


CONCLUSIONS
In the context of similar efficacy for combined treatments, but poorer cost-efficacy, current monotherapies should be considered the first-line treatment of choice for panic disorder. Additionally, CBT emerged as the most durable and cost-effective monotherapy and, hence, should be considered as a particularly valuable treatment from the perspective of cost accountability.
Department of Psychology, Center for Anxiety and Related Disorders, Boston University, Boston, MA 02215, USA. rkmchugh@bu.edu
R Kathryn
RK
McHugh
Michael W
MW
Otto
David H
DH
Barlow
Jack M
JM
Gorman
M Katherine
MK
Shear
Scott W
SW
Woods
D018687:Antidepressive Agents, Second-Generation / Q000191:economics* / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000191:economics* / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007099:Imipramine / Q000191:economics* / Q000627:therapeutic use; D016584:Panic Disorder / Q000188:drug therapy* / Q000191:economics*; D017374:Paroxetine / Q000191:economics* / Q000627:therapeutic use; D016896:Treatment Outcome
D018687:Antidepressive Agents, Second-Generation; D000929:Antidepressive Agents, Tricyclic; D017374:Paroxetine; D007099:Imipramine