title: The Cost of Illness Associated with Stepped Care for Obsessive-Compulsive Disorder.
abstract: Stepped care for obsessive-compulsive disorders (OCD) is a promising approach for improving the accessibility and cost-effectiveness of exposure and response prevention (ERP). Previous research has shown that stepped care is less costly compared with standard, therapist-directed ERP, owing largely to the roughly one-third of patients who respond to lower intensity guided self-help (GSH). The aim of this study was to recalculate the costs of treatment in stepped versus standard care when also including the cost of illness; defined as costs related to functional disability in work, school, and home functioning attributed to OCD symptoms. It was found that the cost savings of stepped care was reduced to a moderate effect (d= 0.66) when the cost of illness was included. Data also indicated substantial potential cost savings if patient-to-treatment matching variables are identified. Exploratory analyses suggested that problems with attention may be an important variable to investigate as a potential treatment moderator in future GSH treatment outcome research. These data highlight the importance of including the cost of illness in cost-effectiveness analyses, and of identifying predictors that will facilitate matched care and prevent unnecessary treatment delay for the roughly two-thirds of patients who will not respond to GSH for OCD.
authors.affiliation: Anxiety Disorders Center The Institute of Living/Hartford Hospital 200 Retreat Avenue Hartford, CT 06106, USA ; Yale University School of Medicine Department of Psychiatry 300 George Street, Suite 901 New Haven, CT 06511.
authors.forename: Gretchen J
authors.initials: GJ
authors.lastname: Diefenbach
authors.forename: David F
authors.initials: DF
authors.lastname: Tolin
keywords: Cost Effectiveness; Cost of Illness; Obsessive-Compulsive Disorder; Personalized Medicine; Stepped Care