Cost-effectiveness analysis of an occupational therapy-led lifestyle approach and routine general practitioner's care for panic disorder.
OBJECTIVE
To assess the cost-effectiveness of an occupational therapy-led lifestyle approach to treating panic disorder in primary care compared with routine general practitioner's (GP) care. The burden of mental health disorders is considerable. Cost-effective interventions are necessary to alleviate some of these burdens. Habitual lifestyle behaviours influence mood, although to date mainly single lifestyle factor trials have been conducted to examine the effects on anxiety.


METHODS
An economic evaluation was conducted alongside an unblinded pragmatic randomised controlled trial with assessment at 5 and 10 months. Costs and consequences, as measured by the Beck anxiety inventory (BAI) and quality adjusted life years (QALYs), were compared using incremental cost-effectiveness ratios (ICERs).


RESULTS
The occupational therapy-led lifestyle intervention was more costly than routine GP care at both 5 and 10 months. Significant outcome improvements were evident at 5 months when using the BAI, although these were not maintained at 10 months. Small differences in mean QALYs were found. The estimated ICER was 36 pounds per BAI improvement for 5 months and 39 pounds for 10 months, and 18,905 pounds per QALY gained for 5 months and 8,283 pounds for 10 months.


CONCLUSIONS
If the maximum willingness to pay per additional QALY is 30,000 pounds, then there is an 86% chance that a lifestyle intervention may be considered to be value-for-money over 10 months.
Lambert
Rodney A
RA
School of Allied Health Professions, University of East Anglia, Norwich, UK. r.lambert@uea.ac.uk
Lorgelly
Paula
P
Harvey
Ian
I
Poland
Fiona
F
D000328:Adult; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008019:Life Style; D008297:Male; D009788:Occupational Therapy / Q000191:economics* / Q000379:methods; D016584:Panic Disorder / Q000191:economics / Q000628:therapy*; D010555:Personality Inventory; D010821:Physicians, Family / Q000191:economics*; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome
Health Econ. 2004 Sep;13(9):873-84
15362179
Psychother Psychosom. 2004 Sep-Oct;73(5):286-92
15292626
Health Econ. 1997 Jul-Aug;6(4):327-40
9285227
J Consult Clin Psychol. 1999 Aug;67(4):583-9
10450630
J Psychiatr Ment Health Nurs. 2004 Aug;11(4):476-83
15255923
Soc Psychiatry Psychiatr Epidemiol. 2009 Jul;44(7):569-78
19011721
J Psychosom Res. 1998 Jan;44(1):107-20
9483468
Nutr Rev. 2003 May;61(5 Pt 2):S61-7
12828194
Eur Neuropsychopharmacol. 2004 Mar;14(2):135-42
15013029
BMJ. 1990 Jan 27;300(6719):230-5
2106931
Am J Psychiatry. 2005 May;162(5):836-46
15863782
Proc Natl Acad Sci U S A. 2003 Mar 4;100(5):2550-5
12604791
Health Econ. 1994 Sep-Oct;3(5):309-19
7827647
J Clin Psychiatry. 2007 Jul;68(7):1038-44
17685740
Psychol Med. 2006 Mar;36(3):353-63
16403243
J Psychiatr Res. 2001 Sep-Oct;35(5):279-86
11591430
Acta Psychiatr Scand. 2005 Apr;111(4):272-85
15740463
Neuropsychopharmacology. 2003 Sep;28(9):1694-702
12825092
Health Technol Assess. 2006 Sep;10(33):iii, xi-xiv, 1-168
16959169
Health Policy. 1996 Jul;37(1):53-72
10158943
Health Econ. 2005 May;14(5):487-96
15497198
Am J Psychiatry. 1999 May;156(5):739-44
10327907
Soc Psychiatry Psychiatr Epidemiol. 2005 Apr;40(4):283-90
15834779
Arch Gen Psychiatry. 1997 Apr;54(4):305-9
9107146
Am J Med Genet C Semin Med Genet. 2008 May 15;148C(2):118-26
18412108
Aust N Z J Psychiatry. 2003 Dec;37(6):641-56
14636376
Prog Neuropsychopharmacol Biol Psychiatry. 2002 Oct;26(6):1079-87
12452529
J Psychosom Res. 1998 Jan;44(1):91-105
9483467
Behav Modif. 2008 May;32(3):333-51
18391051
Br J Psychiatry. 2004 Jul;185:55-62
15231556
Depress Anxiety. 1997;6(4):147-53
9559284
Health Technol Assess. 2002;6(22):1-89
12433315
Depress Anxiety. 2005;21(4):178-84
16075454
Int J Epidemiol. 1998 Apr;27(2):199-207
9602399
Depress Anxiety. 2003;17(2):58-64
12621593
Am J Gastroenterol. 2004 Feb;99(2):370-6
15046231
Br J Gen Pract. 2001 Oct;51(471):838-45
11677710
BMJ. 2004 May 8;328(7448):1102
15130978
J Am Acad Child Adolesc Psychiatry. 2002 Aug;41(8):947-54
12162630
Aust N Z J Psychiatry. 2004 Aug;38(8):602-12
15298582
Eur J Neurosci. 2002 Feb;15(3):528-38
11876780
J Affect Disord. 2007 Apr;99(1-3):63-71
17014912
BMJ. 2001 Dec 1;323(7324):1300-3
11731399
Soc Psychiatry Psychiatr Epidemiol. 2010 Mar;45(3):309-17
19468662
Prog Neuropsychopharmacol Biol Psychiatry. 2004 Sep;28(6):969-73
15380857
Am J Med Genet. 2000 Feb 7;96(1):24-35
10686548
Arch Gen Psychiatry. 2003 Jul;60(7):692-700
12860773
Psychiatry Res. 2003 Dec 1;121(2):185-96
14656453