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

Filip Smit^1,2, Godelief Willemse¹, Peter Meulenbeek³

¹Centre of Prevention and Early Intervention, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, the Netherlands.

Cost Effectiveness and Resource Allocation : C/E

|April 28, 2009

Summary

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Preventing panic disorder with cognitive-behavioral therapy may be cost-effective. Early intervention shows promise, especially with minimal therapist time, but larger trials are needed for confirmation.

Area of Science:

Psychiatry
Health Economics

Background:

Panic disorder presents a significant public health challenge with substantial societal costs.
Preventive interventions are crucial to reduce the incidence of panic disorder and its associated burdens.
This study provides the first economic evaluation of a panic disorder prevention intervention.

Purpose of the Study:

To evaluate the cost-effectiveness of a time-limited cognitive-behavioral therapy (CBT) intervention for preventing panic disorder.
To compare the economic impact of CBT versus care-as-usual in individuals with panic disorder symptoms.

Main Methods:

A randomized trial involving 117 participants with panic disorder symptoms was conducted.
Interventions included time-limited CBT and care-as-usual, with the primary outcome being panic disorder-free survival over 3 months.

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Cost-effectiveness was assessed from a societal perspective using incremental cost-effectiveness ratios and bootstrap analysis.

Main Results:

The median incremental cost-effectiveness ratio was €6,198 per panic disorder-free survival gained.
The intervention demonstrated a 75.2% likelihood of being more cost-effective than care-as-usual, assuming a willingness-to-pay threshold of €10,000.
Therapist time was the primary cost driver; reducing therapist hours improved cost-effectiveness.

Conclusions:

The preventive CBT intervention appears potentially acceptable from a cost-effectiveness standpoint, particularly with minimized therapist involvement.
The study's small sample size and short follow-up period necessitate caution in interpreting results.
Further research with larger sample sizes and longer follow-up durations is recommended to confirm findings and guide broad implementation.