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Preventing panic disorder: cost-effectiveness analysis alongside a pragmatic randomised trial

BACKGROUND: Panic disorder affects many people, is associated with a formidable disease burden, and imposes costs on society. The annual influx of new cases of panic disorder is substantial. From the public health perspective it may therefore be a sound policy to reduce the influx of new cases, to m...

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Autores principales: Smit, Filip, Willemse, Godelief, Meulenbeek, Peter, Koopmanschap, Marc, van Balkom, Anton, Spinhoven, Philip, Cuijpers, Pim
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2009
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2680812/
https://www.ncbi.nlm.nih.gov/pubmed/19393084
http://dx.doi.org/10.1186/1478-7547-7-8
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author Smit, Filip
Willemse, Godelief
Meulenbeek, Peter
Koopmanschap, Marc
van Balkom, Anton
Spinhoven, Philip
Cuijpers, Pim
author_facet Smit, Filip
Willemse, Godelief
Meulenbeek, Peter
Koopmanschap, Marc
van Balkom, Anton
Spinhoven, Philip
Cuijpers, Pim
author_sort Smit, Filip
collection PubMed
description BACKGROUND: Panic disorder affects many people, is associated with a formidable disease burden, and imposes costs on society. The annual influx of new cases of panic disorder is substantial. From the public health perspective it may therefore be a sound policy to reduce the influx of new cases, to maintain the quality of life in many people, and to avoid the economic costs associated with the full-blown disorder. For this purpose, prevention is needed. Here we present the first economic evaluation of such an intervention. METHODS: Randomised trial of 117 people with panic disorder symptoms not meeting the diagnostic criteria of DSM-IV panic disorder. The interventions were time-limited cognitive-behavioural therapy v care-as-usual. The central clinical endpoint was DSM-IV panic disorder-free survival over 3 months. Costs were calculated from the societal perspective. Using the bootstrap method, incremental cost-effectiveness ratios were obtained, placed in 95% confidence intervals, projected on the cost-effectiveness plane, and presented as acceptability curves. RESULTS: The median incremental cost-effectiveness ratio is €6,198 (95% CI 2,435 – 60,731) per PD-free survival gained, which has a likelihood of 75.2% of being more acceptable from a cost-effectiveness point of view than care-as-usual when a willingness-to-pay ceiling is assumed of €10,000 per PD-free survival. The most significant cost driver was therapists' time. A sensitivity analysis indicated that cost-effectiveness improves when the number of therapist hours is reduced. CONCLUSION: This is the first economic evaluation alongside a prevention trial in panic disorder. The small sample (n = 117) and the short time horizon of 3 months preclude firm conclusions, but our findings suggest that the intervention may be acceptable from a cost-effectiveness point of view, especially when therapist involvement can be kept minimal. Nevertheless, our results must await replication in a larger trial with longer follow-up times before we can confidently recommend implementation of the intervention on a broad scale. In the light of our findings and given the burden of panic disorder, such a new trial is well worth the effort. TRIAL REGISTRATION: Current Controlled Trials ISRCTN33407455.
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spelling pubmed-26808122009-05-13 Preventing panic disorder: cost-effectiveness analysis alongside a pragmatic randomised trial Smit, Filip Willemse, Godelief Meulenbeek, Peter Koopmanschap, Marc van Balkom, Anton Spinhoven, Philip Cuijpers, Pim Cost Eff Resour Alloc Research BACKGROUND: Panic disorder affects many people, is associated with a formidable disease burden, and imposes costs on society. The annual influx of new cases of panic disorder is substantial. From the public health perspective it may therefore be a sound policy to reduce the influx of new cases, to maintain the quality of life in many people, and to avoid the economic costs associated with the full-blown disorder. For this purpose, prevention is needed. Here we present the first economic evaluation of such an intervention. METHODS: Randomised trial of 117 people with panic disorder symptoms not meeting the diagnostic criteria of DSM-IV panic disorder. The interventions were time-limited cognitive-behavioural therapy v care-as-usual. The central clinical endpoint was DSM-IV panic disorder-free survival over 3 months. Costs were calculated from the societal perspective. Using the bootstrap method, incremental cost-effectiveness ratios were obtained, placed in 95% confidence intervals, projected on the cost-effectiveness plane, and presented as acceptability curves. RESULTS: The median incremental cost-effectiveness ratio is €6,198 (95% CI 2,435 – 60,731) per PD-free survival gained, which has a likelihood of 75.2% of being more acceptable from a cost-effectiveness point of view than care-as-usual when a willingness-to-pay ceiling is assumed of €10,000 per PD-free survival. The most significant cost driver was therapists' time. A sensitivity analysis indicated that cost-effectiveness improves when the number of therapist hours is reduced. CONCLUSION: This is the first economic evaluation alongside a prevention trial in panic disorder. The small sample (n = 117) and the short time horizon of 3 months preclude firm conclusions, but our findings suggest that the intervention may be acceptable from a cost-effectiveness point of view, especially when therapist involvement can be kept minimal. Nevertheless, our results must await replication in a larger trial with longer follow-up times before we can confidently recommend implementation of the intervention on a broad scale. In the light of our findings and given the burden of panic disorder, such a new trial is well worth the effort. TRIAL REGISTRATION: Current Controlled Trials ISRCTN33407455. BioMed Central 2009-04-24 /pmc/articles/PMC2680812/ /pubmed/19393084 http://dx.doi.org/10.1186/1478-7547-7-8 Text en Copyright © 2009 Smit et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Smit, Filip
Willemse, Godelief
Meulenbeek, Peter
Koopmanschap, Marc
van Balkom, Anton
Spinhoven, Philip
Cuijpers, Pim
Preventing panic disorder: cost-effectiveness analysis alongside a pragmatic randomised trial
title Preventing panic disorder: cost-effectiveness analysis alongside a pragmatic randomised trial
title_full Preventing panic disorder: cost-effectiveness analysis alongside a pragmatic randomised trial
title_fullStr Preventing panic disorder: cost-effectiveness analysis alongside a pragmatic randomised trial
title_full_unstemmed Preventing panic disorder: cost-effectiveness analysis alongside a pragmatic randomised trial
title_short Preventing panic disorder: cost-effectiveness analysis alongside a pragmatic randomised trial
title_sort preventing panic disorder: cost-effectiveness analysis alongside a pragmatic randomised trial
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2680812/
https://www.ncbi.nlm.nih.gov/pubmed/19393084
http://dx.doi.org/10.1186/1478-7547-7-8
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