Preventing panic disorder: cost-effectiveness analysis alongside a pragmatic randomised trial
Open accessAbstract
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 euro6,198 (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 euro10,000 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.
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An economic evaluation of the intervention for a subgroup of the sample (people with subthreshold panic disorder) showed that it may be acceptable from a cost-effectiveness point of view.
“An economic evaluation of the intervention for a subgroup of the sample (i.e. people with subthreshold panic disorder) showed that it may be acceptable from a cost-effectiveness point of view. 34”
From Early intervention in panic: Pragmatic randomised controlled trial (2010) · cites this paper as [34]
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- Authors
- Smit, F., Willemse, G., Meulenbeek, P., Koopmanschap, M., van Balkom, A., Spinhoven, P., & Cuijpers, P.
- Affiliations
- Trimbos Institute (NL)
- GGNet (NL)
- Erasmus MC (NL)
- Leiden University Medical Center (NL)
- Amsterdam Public Health (NL)
- Corresponding author
- Smit, Filip
- Venue
- Cost Effectiveness and Resource Allocation
- Published
- 2009
- Volume
- 7
- Issue
- 1
- Pages
- 8
- ISSN
- 1478-7547 (ISSN-L)
- PMC
- PMC2680812
- OpenAlex
- W2100530006
- Cited by
- 48
- References
- 37
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 1 · 2021: 2 · 2020: 2 · 2019: 4 · 2018: 3 · 2017: 1 · 2016: 3 · 2015: 1 · 2014: 6 · 2013: 6 · 2012: 5
- FWCI
- 11.98
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Cost Effectiveness and Resource Allocation (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (acceptedVersion)
- VU Research Portal (acceptedVersion, other-oa)
- Pure Amsterdam UMC (submittedVersion)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- RePub (Erasmus University Rotterdam) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- ZonMw
- Trimbos-instituut
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- panic disorder, prevention, cost-effectiveness, cognitive behavioral therapy, time-limited therapy, social costs, acceptability curves, willingness to pay
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