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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...
Autores principales: | , , , , , , |
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Formato: | Texto |
Lenguaje: | English |
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BioMed Central
2009
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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. |
format | Text |
id | pubmed-2680812 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2009 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
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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