title: Incremental cost-effectiveness of pharmacotherapy and two brief cognitive-behavioral therapies compared with usual care for panic disorder and noncardiac chest pain.
abstract: The aim of this study was to assess the incremental cost-effectiveness ratios (ICERs) of two brief cognitive-behavioral therapy (CBT)-based interventions and a pharmacological treatment, compared with usual care, initiated in the emergency department (ED) for individuals with panic disorder (PD) with a chief complaint of noncardiac chest pain. A total of 69 patients were followed up to 6 months. The primary outcome variables were direct and indirect costs of treatment and PD severity. Panic management (PM) had an ICER of $124.05, per the Anxiety Disorders Interview Schedule for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, severity score change (95% confidence interval [CI], $54.63-$314.57), compared with pharmacotherapy (paroxetine), with an ICER of $213.90 (95% CI, $133.51-$394.94), and brief CBT, with an ICER of $309.31 (95% CI, $151.27-$548.28). The pharmacological and CBT interventions were associated with a greater clinical improvement compared with usual care at posttest. PM presented a superior ICER, suggesting that it may be a promising treatment option to implement in EDs.
authors.affiliation: Psychology Department, Université du Québec à Montréal, Montreal, Quebec, Canada.
authors.forename: Joannie
authors.initials: J
authors.lastname: Poirier-Bisson
authors.forename: André
authors.initials: A
authors.lastname: Marchand
authors.forename: Marie-Eve
authors.initials: ME
authors.lastname: Pelland
authors.forename: Marie-Josée
authors.initials: MJ
authors.lastname: Lessard
authors.forename: Gilles
authors.initials: G
authors.lastname: Dupuis
authors.forename: Richard
authors.initials: R
authors.lastname: Fleet
authors.forename: Pasquale
authors.initials: P
authors.lastname: Roberge
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018687:Antidepressive Agents, Second-Generation / Q000191:economics* / Q000627:therapeutic use*; D002637:Chest Pain / Q000191:economics* / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000191:economics*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis / Q000191:economics; D016527:Drug Costs / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000191:economics* / Q000523:psychology / Q000628:therapy*; D017374:Paroxetine / Q000191:economics* / Q000627:therapeutic use*; D011614:Psychotherapy, Brief / Q000191:economics*; D011792:Quebec; D055815:Young Adult
chemical_list: D018687:Antidepressive Agents, Second-Generation; D017374:Paroxetine