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[Tree decision analysis of the therapeutic alternatives for Panic Disorders in Primary Care]
Fernando Navarro-Mateu1, Ascensión Garriga-Puerto, Juan Antonio Sánchez-Sánchez
1Unidad de Docencia, Servicio Murciano de Salud, Murcia, España. fernando.navarro@carm.es
Aims:
To analyse the different therapeutic alternatives for Panic Disorders to make it easier to make collaborative treatment decisions between patients and doctors in a Primary Care setting.
Design:
Quantitative analysis by a decision tree.
Data Sources:
Time period reviewed; 1990-2008 in Med-line, Embase, Cochrane-plus Library and Tripdatabase. Terms used "panic disorder", "psychotherapy" and "drug therapy".
Methods:
I) A decision tree was prepared with only one therapeutic option in each arm; II) The same procedure with two sequential therapeutic options; III) Sensitivity analysis to test the robustness of the model.
Study Selection:
Evidence summary, systematic reviews, meta-analysis and clinical guidelines.
Results:
Cognitive-Behavioural Therapy (CBT) obtains the highest usefulness (UME=0.58), followed by the Selective serotonin reuptake inhibitors (SSRI) (UME=0.53) and by the tricyclic antidepressants (UME=0.44). CBT followed by SSRI is the therapeutic sequence with the highest usefulness (0.62). The sensitivity analysis suggests the model is not robust enough.
Conclusions:
The CBT in monotherapy or followed by SSRI in a sequential strategy would be the options with the highest usefulness. The results are not robust enough because they can clearly vary with changes in the most important variables in a reasonable range.
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