title: Cost-effectiveness analysis of an occupational therapy-led lifestyle approach and routine general practitioner's care for panic disorder.
abstract: 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.
authors.affiliation: School of Allied Health Professions, University of East Anglia, Norwich, UK. r.lambert@uea.ac.uk
authors.forename: Rodney A
authors.initials: RA
authors.lastname: Lambert
authors.forename: Paula
authors.initials: P
authors.lastname: Lorgelly
authors.forename: Ian
authors.initials: I
authors.lastname: Harvey
authors.forename: Fiona
authors.initials: F
authors.lastname: Poland
mesh_terms: 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
references.citation: Health Econ. 2004 Sep;13(9):873-84
references.pmid: 15362179
references.citation: Psychother Psychosom. 2004 Sep-Oct;73(5):286-92
references.pmid: 15292626
references.citation: Health Econ. 1997 Jul-Aug;6(4):327-40
references.pmid: 9285227
references.citation: J Consult Clin Psychol. 1999 Aug;67(4):583-9
references.pmid: 10450630
references.citation: J Psychiatr Ment Health Nurs. 2004 Aug;11(4):476-83
references.pmid: 15255923
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2009 Jul;44(7):569-78
references.pmid: 19011721
references.citation: J Psychosom Res. 1998 Jan;44(1):107-20
references.pmid: 9483468
references.citation: Nutr Rev. 2003 May;61(5 Pt 2):S61-7
references.pmid: 12828194
references.citation: Eur Neuropsychopharmacol. 2004 Mar;14(2):135-42
references.pmid: 15013029
references.citation: BMJ. 1990 Jan 27;300(6719):230-5
references.pmid: 2106931
references.citation: Am J Psychiatry. 2005 May;162(5):836-46
references.pmid: 15863782
references.citation: Proc Natl Acad Sci U S A. 2003 Mar 4;100(5):2550-5
references.pmid: 12604791
references.citation: Health Econ. 1994 Sep-Oct;3(5):309-19
references.pmid: 7827647
references.citation: J Clin Psychiatry. 2007 Jul;68(7):1038-44
references.pmid: 17685740
references.citation: Psychol Med. 2006 Mar;36(3):353-63
references.pmid: 16403243
references.citation: J Psychiatr Res. 2001 Sep-Oct;35(5):279-86
references.pmid: 11591430
references.citation: Acta Psychiatr Scand. 2005 Apr;111(4):272-85
references.pmid: 15740463
references.citation: Neuropsychopharmacology. 2003 Sep;28(9):1694-702
references.pmid: 12825092
references.citation: Health Technol Assess. 2006 Sep;10(33):iii, xi-xiv, 1-168
references.pmid: 16959169
references.citation: Health Policy. 1996 Jul;37(1):53-72
references.pmid: 10158943
references.citation: Health Econ. 2005 May;14(5):487-96
references.pmid: 15497198
references.citation: Am J Psychiatry. 1999 May;156(5):739-44
references.pmid: 10327907
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2005 Apr;40(4):283-90
references.pmid: 15834779
references.citation: Arch Gen Psychiatry. 1997 Apr;54(4):305-9
references.pmid: 9107146
references.citation: Am J Med Genet C Semin Med Genet. 2008 May 15;148C(2):118-26
references.pmid: 18412108
references.citation: Aust N Z J Psychiatry. 2003 Dec;37(6):641-56
references.pmid: 14636376
references.citation: Prog Neuropsychopharmacol Biol Psychiatry. 2002 Oct;26(6):1079-87
references.pmid: 12452529
references.citation: J Psychosom Res. 1998 Jan;44(1):91-105
references.pmid: 9483467
references.citation: Behav Modif. 2008 May;32(3):333-51
references.pmid: 18391051
references.citation: Br J Psychiatry. 2004 Jul;185:55-62
references.pmid: 15231556
references.citation: Depress Anxiety. 1997;6(4):147-53
references.pmid: 9559284
references.citation: Health Technol Assess. 2002;6(22):1-89
references.pmid: 12433315
references.citation: Depress Anxiety. 2005;21(4):178-84
references.pmid: 16075454
references.citation: Int J Epidemiol. 1998 Apr;27(2):199-207
references.pmid: 9602399
references.citation: Depress Anxiety. 2003;17(2):58-64
references.pmid: 12621593
references.citation: Am J Gastroenterol. 2004 Feb;99(2):370-6
references.pmid: 15046231
references.citation: Br J Gen Pract. 2001 Oct;51(471):838-45
references.pmid: 11677710
references.citation: BMJ. 2004 May 8;328(7448):1102
references.pmid: 15130978
references.citation: J Am Acad Child Adolesc Psychiatry. 2002 Aug;41(8):947-54
references.pmid: 12162630
references.citation: Aust N Z J Psychiatry. 2004 Aug;38(8):602-12
references.pmid: 15298582
references.citation: Eur J Neurosci. 2002 Feb;15(3):528-38
references.pmid: 11876780
references.citation: J Affect Disord. 2007 Apr;99(1-3):63-71
references.pmid: 17014912
references.citation: BMJ. 2001 Dec 1;323(7324):1300-3
references.pmid: 11731399
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2010 Mar;45(3):309-17
references.pmid: 19468662
references.citation: Prog Neuropsychopharmacol Biol Psychiatry. 2004 Sep;28(6):969-73
references.pmid: 15380857
references.citation: Am J Med Genet. 2000 Feb 7;96(1):24-35
references.pmid: 10686548
references.citation: Arch Gen Psychiatry. 2003 Jul;60(7):692-700
references.pmid: 12860773
references.citation: Psychiatry Res. 2003 Dec 1;121(2):185-96
references.pmid: 14656453