Cost-effectiveness of a primary care model for anxiety disorders.
BACKGROUND
Individuals with anxiety disorders often do not receive an accurate diagnosis or adequate treatment in primary care.


OBJECTIVE
To analyse the cost-effectiveness of an optimised care model for people with anxiety disorders in primary care.


METHODS
In a cluster randomised controlled trial, 46 primary care practices with 389 individuals positively screened with anxiety were randomised to intervention (23 practices, 201 participants) or usual care (23 practices, 188 participants). Physicians in the intervention group received training on diagnosis and treatment of anxiety disorders combined with the offer of a psychiatric consultation-liaison service for 6 months. Anxiety, depression, quality of life, service utilisation and costs were assessed at baseline, 6-month and 9-month follow-up.


RESULTS
No significant differences were observed between intervention and control group on the Beck Anxiety Inventory, Beck Depression Inventory and EQ-5D during follow-up. Total costs were higher in the intervention group (euro4911 v. euro3453, P = 0.09). The probability of an incremental cost-effectiveness ratio <euro50 000 per quality-adjusted life year was below 10%.


CONCLUSIONS
The optimised care model did not prove to be cost-effective.
Health Economics Research Unit, Department of Psychiatry, University of Leipzig, Germany. hans-helmut.koenig@medizin.uni-leipzig.de
Hans-Helmut
HH
König
Anja
A
Born
Dirk
D
Heider
Herbert
H
Matschinger
Sven
S
Heinrich
Steffi G
SG
Riedel-Heller
Daniel
D
Surall
Matthias C
MC
Angermeyer
Christiane
C
Roick
D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000191:economics / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000191:economics* / Q000193:education; D003362:Cost-Benefit Analysis; D005194:Family Practice / Q000191:economics* / Q000193:education / Q000379:methods; D005858:Germany; D006801:Humans; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D055815:Young Adult