title: Cost-effectiveness of CBT, SSRI, and CBT+SSRI in the treatment for panic disorder.
abstract: OBJECTIVE
  The objective of this study was to assess the cost-effectiveness of three empirically supported treatments for panic disorder with or without agoraphobia: cognitive behavioral therapy (CBT), pharmacotherapy using a selective serotonin reuptake inhibitor (SSRI), or the combination of both (CBT+SSRI).
  
  
  METHODS
  Cost-effectiveness was examined based on the data from a multicenter randomized controlled trial. The Hamilton Anxiety Rating Scale was selected as a primary health outcome measure. Data on costs from a societal perspective (i.e., direct medical, direct non-medical, and indirect non-medical costs) were collected in the study sample (N=150) throughout a 24-month period in which patients received active treatment during the first twelve months and were seen twice for follow-up in the next twelve months.
  
  
  RESULTS
  Total costs were largely influenced by costs of the interventions and productivity losses. The mean total societal costs were lower for CBT as compared to SSRI and CBT+SSRI. Costs of medication use were substantial for both SSRI and CBT+SSRI. When examining the balance between costs and health outcomes, both CBT and CBT+SSRI led to more positive outcomes than SSRI.
  
  
  CONCLUSIONS
  Cognitive behavioral therapy is associated with the lowest societal costs. Cognitive behavioral therapy and CBT+SSRI are more cost-effective treatments for panic disorder with or without agoraphobia as compared to SSRI only.
authors.affiliation: University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: F J
authors.initials: FJ
authors.lastname: van Apeldoorn
authors.forename: A D
authors.initials: AD
authors.lastname: Stant
authors.forename: W J P J
authors.initials: WJ
authors.lastname: van Hout
authors.forename: P P A
authors.initials: PP
authors.lastname: Mersch
authors.forename: J A
authors.initials: JA
authors.lastname: den Boer
mesh_terms: D000293:Adolescent; D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000191:economics / Q000379:methods; D003131:Combined Modality Therapy / Q000191:economics / Q000379:methods; D003362:Cost-Benefit Analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000188:drug therapy / Q000191:economics* / Q000628:therapy*; D017367:Selective Serotonin Reuptake Inhibitors / Q000191:economics / Q000494:pharmacology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors
keywords: agoraphobia; cognitive behavioral therapy; cost-effectiveness analysis; drug treatment; economic evaluation; panic disorder; randomized controlled trial