Cost-effectiveness of psychological and pharmacological interventions for generalized anxiety disorder and panic disorder

Heuzenroeder, Louise; Donnelly, Marie; Haby, Michelle M.; Mihalopoulos, Cathrine; Rossell, Ruth; Carter, Rob; Andrews, Gavin; Vos, Theo

doi:10.1111/j.1440-1614.2004.01423.x

Cited by 27 publications

(24 citation statements)

References 33 publications

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“…Of the five cost-effectiveness analyses focusing on GAD,23,39–42 three used DSM-IV diagnostic criteria for GAD (the others used ICD-10 codification), and only one of them presented QALY gain as a measure of effectiveness, then incorporating both quantity and quality of life in a combined summary effectiveness measurement. Guest et al examined the cost-effectiveness of venlafaxine XL versus diazepam over 6 months from the perspective of the UK National Health Service.…”

Section: Discussionmentioning

confidence: 99%

“…In terms of cost, comparing the total health care costs shown by our analysis with those in the studies cited above, our analysis seems more complete because the costs of all medical visits and hospitalization were included, in addition to nonpharmacological treatment. As pointed out in a systematic review published in 2009,44 it would be useful to agree on measures of effectiveness used in cost-effectiveness analysis, eg, standard measures of QALY gained, or perhaps disability-adjusted life years avoided, which is recommended in most guidelines for financial evaluation and assessment of health technologies 39,45,46. Assuming that any analysis of the real situation carries some degree of uncertainty, a sensitivity analysis of 10,000 samples using bootstrapping techniques was carried out to minimize errors and increase the certainty of cost estimates and QALY gained over the total duration of the study, thereby determining the robustness of the analysis and its conclusions.…”

Section: Discussionmentioning

confidence: 99%

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Pregabalin versus SSRIs and SNRIs in benzodiazepine-refractory outpatients with generalized anxiety disorder: a post hoc cost-effectiveness analysis in usual medical practice in Spain

Salas-Cansado¹,

Olivares²,

Álvarez³

et al. 2012

CEOR

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BackgroundGeneralized anxiety disorder (GAD) is a prevalent health condition which seriously affects both patient quality of life and the National Health System. The aim of this research was to carry out a post hoc cost-effectiveness analysis of the effect of pregabalin versus selective serotonin reuptake inhibitors (SSRIs)/serotonin norepinephrine reuptake inhibitors (SNRIs) in treated benzodiazepine-refractory outpatients with GAD.MethodsThis post hoc cost-effectiveness analysis used secondary data extracted from the 6-month cohort, prospective, noninterventional ADAN study, which was conducted to ascertain the cost of illness in GAD subjects diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Benzodiazepine-refractory subjects were those who claimed persistent symptoms of anxiety and showed a suboptimal response (Hamilton Anxiety Rating Scale ≥ 16) to benzodiazepines, alone or in combination, over 6 months. Patients could switch to pregabalin (as monotherapy or addon) or to an SSRI or SNRI, alone or in combination. Effectiveness was expressed as quality-adjusted life years gained, and the perspective was that of the National Health System in the year 2008. A sensitivity analysis was performed using bootstrapping techniques (10,000 resamples were obtained) in order to obtain a cost-effectiveness plane and a corresponding acceptability curve.ResultsA total of 282 subjects (mean Hamilton Anxiety Rating Scale score 25.8) were identified, comprising 157 in a pregabalin group and 125 in an SSRI/SNRI group. Compared with SSRI/SNRI, pregabalin (average dose 163 mg/day) was associated with higher quality-adjusted life years gained (0.1086 ± 0.0953 versus 0.0967 ± 0.1003, P = 0.334), but increased health care costs (€1014 ± 762 versus €846 ± 620, P = 0.166) and drug costs (€376 ± 252 versus 220 ± 140, P < 0.001), resulting in an incremental cost-effectiveness ratio of €25,304 (95% confidence interval dominant 149,430) per quality-adjusted life years gained for health care costs and €25,454 (dominant 124,562) when drug costs were considered alone. Eighty-six percent of resamples fell below the threshold of €30,000 per quality-adjusted life years.ConclusionThis evaluation suggests that pregabalin may be cost-effective in comparison with SSRIs/SNRIs in benzodiazepine-refractory outpatients with GAD treated in mental health care settings under usual medical practice in Spain.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pregabalin versus SSRIs and SNRIs in benzodiazepine-refractory outpatients with generalized anxiety disorder: a post hoc cost-effectiveness analysis in usual medical practice in Spain

Salas-Cansado¹,

Olivares²,

Álvarez³

et al. 2012

CEOR

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“…Instead, it should be a clinically significant condition which may be especially suitable for early intervention and prevention of secondary morbidity (Ruscio et al , 2007). Future trials should examine whether existing therapies would be cost-effective in treating 1-month GAD and preventing its recurrence and progression to chronicity (Heuzenroeder et al , 2004). …”

Section: Discussionmentioning

confidence: 99%

Implications of modifying the duration requirement of generalized anxiety disorder in developed and developing countries

et al. 2008

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“…Recent research with primary care patients shows that the combination of pharmacotherapy and CBT for panic disorder produces increased quality adjusted life years saved at a cost that is comparable to that achieved by such common preventive interventions as the pharmacologic treatment of hypertension and hypercholesterolemia (Katon et al, 2006; also cf. Heuzenroeder et al, 2004). The listed interventions also have been shown to be cost-effective relative to alternative psychological interventions.…”

Section: Merits Of Psychosocial Interventions and Future Prospects Ofmentioning

confidence: 99%

Current Status and Future Prospects of Clinical Psychology

Baker

McFall

Shoham

2008

Psychol Sci Public Interest

278

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SUMMARYThe escalating costs of health care and other recent trends have made health care decisions of great societal import, with decision-making responsibility often being transferred from practitioners to health economists, health plans, and insurers. Health care decision making increasingly is guided by evidence that a treatment is efficacious, effective-disseminable, cost-effective, and scientifically plausible. Under these conditions of heightened cost concerns and institutional-economic decision making, psychologists are losing the opportunity to play a leadership role in mental and behavioral health care: Other types of practitioners are providing an increasing proportion of delivered treatment, and the use of psychiatric medication has increased dramatically relative to the provision of psychological interventions.Research has shown that numerous psychological interventions are efficacious, effective, and costeffective. However, these interventions are used infrequently with patients who would benefit from them, in part because clinical psychologists have not made a convincing case for the use of these interventions (e.g., by supplying the data that decision makers need to support implementation of such interventions) and because clinical psychologists do not themselves use these interventions even when given the opportunity to do so.Clinical psychologists' failure to achieve a more significant impact on clinical and public health may be traced to their deep ambivalence about the role of science and their lack of adequate science training, which leads them to value personal clinical experience over research evidence, use assessment practices that have dubious psychometric support, and not use the interventions for which there is the strongest evidence of efficacy. Clinical psychology resembles medicine at a point in its history when practitioners were operating in a largely prescientific manner. Prior to the scientific reform of medicine in the early 1900s, physicians typically shared the attitudes of many of today's clinical psychologists, such as valuing personal experience over scientific research. Medicine was reformed, in large part, by a principled effort by the American Medical Association to increase the science base of medical school education. Substantial evidence shows that many clinical psychology doctoral training programs, especially PsyD and for-profit programs, do not uphold high standards for graduate admission, have high student-faculty ratios, deemphasize science in their training, and produce students who fail to apply or generate scientific knowledge.A promising strategy for improving the quality and clinical and public health impact of clinical psychology is through a new accreditation system that demands highquality science training as a central feature of doctoral training in clinical psychology. Just as strengthening training standards in NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript medicine markedly enhanced the quality of health care, improved tra...

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Cost-effectiveness of psychological and pharmacological interventions for generalized anxiety disorder and panic disorder

Cited by 27 publications

References 33 publications

Pregabalin versus SSRIs and SNRIs in benzodiazepine-refractory outpatients with generalized anxiety disorder: a post hoc cost-effectiveness analysis in usual medical practice in Spain

Pregabalin versus SSRIs and SNRIs in benzodiazepine-refractory outpatients with generalized anxiety disorder: a post hoc cost-effectiveness analysis in usual medical practice in Spain

Implications of modifying the duration requirement of generalized anxiety disorder in developed and developing countries

Current Status and Future Prospects of Clinical Psychology

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