title: Long-term cost-effectiveness of cognitive behavioral therapy versus psychodynamic therapy in social anxiety disorder.
abstract: To determine the cost-effectiveness of cognitive behavioral therapy (CBT) versus psychodynamic therapy (PDT) in the treatment of social anxiety disorder after a follow-up of 30 months from a societal perspective.
  
  
  
  This analysis was conducted alongside the multicenter SOPHO-NET trial; adults with a primary diagnosis of social anxiety disorder received CBT (n = 209) or PDT (n = 207). Data on health care utilization and productivity loss were collected at baseline, after 6 months (posttreatment), and three further follow-ups to calculate direct and indirect costs. Anxiety-free days (AFDs) calculated based on remission and response were used as measure of effect. The incremental cost-effectiveness ratio (ICER) was determined. Net benefit regressions, adjusted for comorbidities and baseline differences, were applied to derive cost-effectiveness acceptability curves.
  
  
  
  In the descriptive analysis, the unadjusted ICER favored CBT over PDT and the adjusted analysis showed that CBT's cost-effectiveness relative to PDT depends on the willingness to pay (WTP) per AFD. As baseline costs differed substantially the unadjusted estimates might be deceptive. If additional WTPs for CBT of €0, €10, and €30 were assumed, the probability of CBT being cost-effective relative to PDT was 65, 83, and 96%. Direct costs increased compared to baseline across groups, whereas indirect costs did not change significantly. Results were sensitive to considered costs.
  
  
  
  If the society is willing to pay ≥€30 per additional AFD, CBT can be considered cost-effective, relative to PDT, with certainty. To further increase the cost-effectiveness more knowledge regarding predictors of treatment outcome seems essential.
authors.affiliation: Department of Health Economics and Health Services Research, Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Nina
authors.initials: N
authors.lastname: Egger
authors.affiliation: Department of Health Economics and Health Services Research, Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Konnopka
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
authors.forename: Manfred E
authors.initials: ME
authors.lastname: Beutel
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, LWL University Clinic Bochum, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Herpertz
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hiller
authors.affiliation: Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany.
authors.forename: Juergen
authors.initials: J
authors.lastname: Hoyer
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medicine, Georg-August-University, Goettingen, Germany.
authors.forename: Simone
authors.initials: S
authors.lastname: Salzer
authors.affiliation: Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Stangier
authors.affiliation: Institute of Psychosocial Medicine and Psychotherapy, University Hospital Jena, Jena, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Strauss
authors.affiliation: Clinical Psychology and Psychotherapy, University Witten/Herdecke, Witten, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Willutzki
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
authors.forename: Joerg
authors.initials: J
authors.lastname: Wiltink
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medicine, Georg-August-University, Goettingen, Germany.
authors.forename: Eric
authors.initials: E
authors.lastname: Leibing
authors.affiliation: Clinic of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany.
authors.forename: Falk
authors.initials: F
authors.lastname: Leichsenring
authors.affiliation: Department of Health Economics and Health Services Research, Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Hans-Helmut
authors.initials: HH
authors.lastname: König
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D000072861:Phobia, Social / Q000191:economics* / Q000628:therapy*; D064889:Psychotherapy, Psychodynamic / Q000191:economics* / Q000379:methods; D013995:Time; D016896:Treatment Outcome
keywords: costs; economic evaluation; multiple imputation; net benefit regression; psychotherapy