title: Short-term cost-effectiveness of psychodynamic therapy and cognitive-behavioral therapy in social anxiety disorder: Results from the SOPHO-NET trial.
abstract: BACKGROUND
  To investigate the short-term cost-effectiveness of cognitive-behavioral therapy (CBT) and psychodynamic therapy (PDT) compared to waiting list (WL).
  
  
  METHODS
  The analysis was conducted alongside the SOPHO-NET multi-center efficacy trial. Patients were randomly assigned to CBT (n=209), PDT (n=207), or WL (n=79). Resource use was assessed prior and during treatment to determine direct and absenteeism costs. Unadjusted incremental cost-effectiveness ratios (ICERs) were calculated based on remission and response rates. To visualize statistical uncertainty, cost-effectiveness acceptability curves (CEACs) were constructed based on adjusted net-benefit regression. Different values for the society׳s willingness to pay (WTP) were assumed.
  
  
  RESULTS
  Both interventions were more efficacious than WL but were associated with increased direct costs besides intervention costs. Unadjusted ICERs per responder were €3615 for CBT and €4958 for PDT. Unadjusted ICERs per remitted patient were €5788 and €10,733. CEACs revealed a high degree of uncertainty: applying the 97.5% probability threshold, CBT proved cost-effective at a WTP ≥€16,100 per responder and ≥€26,605 per remitted patient. Regarding PDT cost-effectiveness only was certain for response at a WTP ≥€27,290.
  
  
  CONCLUSIONS
  The WL condition is assumed to represent untreated patients, although the expectation to start treatment in the near future probably affects symptom severity and health care utilization.
  
  
  CONCLUSIONS
  At the end of treatment cost-effectiveness of CBT and PDT compared to WL is uncertain and depends on the societal WTP. The interventions may induce a more adequate utilization of other health care services - involving increased costs. Development of costs and effects in the long-run should be considered.
authors: Department of Health Economics and Health Services Research, Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf, Germany. Electronic address: n.egger@uke.de.
authors: Nina
authors: N
authors: Egger
authors: Department of Health Economics and Health Services Research, Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf, Germany.
authors: Alexander
authors: A
authors: Konnopka
authors: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Germany.
authors: Manfred E
authors: ME
authors: Beutel
authors: Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum, Ruhr-University Bochum, Germany.
authors: Stephan
authors: S
authors: Herpertz
authors: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Germany.
authors: Wolfgang
authors: W
authors: Hiller
authors: Clinical Psychology and Psychotherapy and Clinic for Psychotherapy and Psychosomatic Medicine, Technische Universitaet Dresden, Germany.
authors: Juergen
authors: J
authors: Hoyer
authors: Department of Psychosomatic Medicine and Psychotherapy, University Medicine, Georg-August-University Goettingen, Germany.
authors: Simone
authors: S
authors: Salzer
authors: Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Germany.
authors: Ulrich
authors: U
authors: Stangier
authors: Institute of Psychosocial Medicine and Psychotherapy, University Hospital Jena, Germany.
authors: Bernhard
authors: B
authors: Strauss
authors: Clinical Psychology and Psychotherapy, University Witten/Herdecke, Germany.
authors: Ulrike
authors: U
authors: Willutzki
authors: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Germany.
authors: Joerg
authors: J
authors: Wiltink
authors: Clinic of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Germany.
authors: Falk
authors: F
authors: Leichsenring
authors: Department of Psychosomatic Medicine and Psychotherapy, University Medicine, Georg-August-University Goettingen, Germany.
authors: Eric
authors: E
authors: Leibing
authors: Department of Health Economics and Health Services Research, Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf, Germany.
authors: Hans-Helmut
authors: HH
authors: König
mesh_terms: D015928:Cognitive Behavioral Therapy / Q000191:economics* / Q000379:methods*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D010698:Phobic Disorders / Q000523:psychology* / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists
keywords: Cognitive-behavioral therapy; Cost-effectiveness; Economic evaluation; Psychodynamic therapy; Social anxiety disorder