title: Cost utility analysis of a collaborative stepped care intervention for panic and generalized anxiety disorders in primary care.
abstract: OBJECTIVE
  Generalized anxiety and panic disorders are a burden on the society because they are costly and have a significant adverse effect on quality of life. The aim of this study was to evaluate the cost-utility of a collaborative stepped care intervention for panic disorder and generalized anxiety disorder in primary care compared to care as usual from a societal perspective.
  
  
  METHODS
  The design of the study was a two armed cluster randomized controlled trial. In total 43 primary care practices in the Netherlands participated in the study. Eventually, 180 patients were included (114 collaborative stepped care, 66 care as usual). Baseline measures and follow-up measures (3, 6, 9 and 12 months) were assessed using questionnaires. We applied the TiC-P, the SF-HQL and the EQ-5D respectively measuring health care utilization, production losses and health related quality of life.
  
  
  RESULTS
  The average annual direct medical costs in the collaborative stepped care group were 1854 Euro (95% C.I., 1726 to 1986) compared to €1503 (95% C.I., 1374 to 1664) in the care as usual group. The average quality of life years (QALYs) gained was 0.05 higher in the collaborative stepped care group, leading to an incremental cost effectiveness ratio (ICER) of 6965 Euro per QALY. Inclusion of the productivity costs, consequently reflecting the full societal costs, decreased the ratio even more.
  
  
  CONCLUSIONS
  The study showed that collaborative stepped care was a cost effective intervention for panic disorder and generalized anxiety disorder and was even dominant when a societal perspective was taken.
  
  
  BACKGROUND
  trialregister.nl, Netherlands Trial Register NTR107.
authors.affiliation: Institute for Medical Technology Assessment, Institute of Health Policy & Management, PO Box 1783, Rotterdam, The Netherlands. Electronic address: Goorden@bmg.eur.nl.
authors.forename: Maartje
authors.initials: M
authors.lastname: Goorden
authors.affiliation: Netherlands Institute of Mental Health and Addiction (Trimbos Institute), PO Box 725, Utrecht, The Netherlands; Faculty of Social Sciences, Tranzo Department, Tilburg University, PO Box 90153, Tilburg, The Netherlands; Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Anna
authors.initials: A
authors.lastname: Muntingh
authors.affiliation: Department of General Practice, VU University Medical Centre, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research (EMGO+), PO Box 7057, Amsterdam, The Netherlands.
authors.forename: Harm
authors.initials: H
authors.lastname: van Marwijk
authors.affiliation: Institute of Psychology, Leiden University, PO Box 9555, Leiden, The Netherlands; Department of Psychiatry, Leiden University Medical Centre, PO Box 9600, Leiden, The Netherlands.
authors.forename: Philip
authors.initials: P
authors.lastname: Spinhoven
authors.affiliation: Johannes van Kessel Advising, Huizen, The Netherlands.
authors.forename: Herman
authors.initials: H
authors.lastname: Adèr
authors.affiliation: Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Anton
authors.initials: A
authors.lastname: van Balkom
authors.affiliation: Netherlands Institute of Mental Health and Addiction (Trimbos Institute), PO Box 725, Utrecht, The Netherlands; Clinical Centre for Body, Mind and Health, GGZ Breburg, Tilburg, The Netherlands; Faculty of Social Sciences, Tranzo Department, Tilburg University, PO Box 90153, Tilburg, The Netherlands.
authors.forename: Christina
authors.initials: C
authors.lastname: van der Feltz-Cornelis
authors.affiliation: Institute for Medical Technology Assessment, Institute of Health Policy & Management, PO Box 1783, Rotterdam, The Netherlands.
authors.forename: Leona
authors.initials: L
authors.lastname: Hakkaart-van Roijen
mesh_terms: D001008:Anxiety Disorders / Q000191:economics / Q000628:therapy*; D003299:Cooperative Behavior; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D016584:Panic Disorder / Q000191:economics / Q000628:therapy*; D011320:Primary Health Care / Q000191:economics* / Q000379:methods*; D011788:Quality of Life
keywords: Anxiety; Cost utility; Panic; Randomized trial; Societal perspective; Stepped care