Abstract
BackgroundPrimary care is the main treatment setting for panic disorder and should be supplemented by collaborative care programs. However, shortage of mental health professionals prevents collaborative care programs from being effectively implemented. The PARADISE study showed the efficacy of a self-managed, cognitive-behavioural therapy (CBT)-oriented exposure training for patients with panic disorder with or without agoraphobia in primary care delivered by the family practice team.ObjectiveTo assess the cost-effectiveness of the PARADISE intervention.DesignCost-effectiveness analysis from the societal perspective based on data from a cluster-randomized controlled trial over a time horizon of 12 months.ParticipantsFour hundred nineteen adult panic disorder patients with or without agoraphobia.InterventionsA self-managed, CBT-oriented exposure training for patients with panic disorder with or without agoraphobia in primary care delivered by the primary care practice team in comparison to routine care.Main MeasuresTotal costs from the societal perspective. Direct costs and disease-specific costs. Quality-adjusted life years based on the EQ-5D-3L. Incremental cost-effectiveness ratios and cost-effectiveness acceptability curves.Key ResultsPatients in the intervention group caused lower costs (mean, €1017; 95% confidence interval [-€3306; €1272]; p = 0.38) and gained on average more QALY (mean, 0.034 QALY (95% confidence interval [0.005; 0.062]; p = 0.02). Therefore, the intervention dominated the control treatment. The probability of cost-effectiveness of the intervention at a willingness-to-pay margin of €50,000 per QALY was 96%. Results from supplementary analyses considering direct or disease-specific costs instead of total costs showed comparable results.ConclusionThe PARADISE intervention is cost effective. This conclusion is valid for total costs, generic health care (direct) costs, disease-specific health care costs.Trial RegistrationGerman Clinical Trials Register: DRKS00004386Current Controlled Trials: ISRCTN64669297
Highlights
Panic disorder is defined by recurrent unexpected panic attacks and worries about future attacks and/or the avoidance of specific situations.[1]
We present evidence on the cost-effectiveness of the PARADISE intervention in comparison to usual primary care
We considered indirect costs in the market sector, i.e. productivity losses caused by sick leave and by contacts with health care professionals during working hours.[22]
Summary
Panic disorder is defined by recurrent unexpected panic attacks and worries about future attacks and/or the avoidance of specific situations.[1]. Patients avoid these situations.[1] Panic disorder and agoraphobia often cooccur (30–60%).[2]. Primary care is the main treatment setting for panic disorder and should be supplemented by collaborative care programs. The PARADISE study showed the efficacy of a self-managed, cognitivebehavioural therapy (CBT)-oriented exposure training for patients with panic disorder with or without agoraphobia in primary care delivered by the family practice team. OBJECTIVE: To assess the cost-effectiveness of the PARADISE intervention. DESIGN: Cost-effectiveness analysis from the societal perspective based on data from a cluster-randomized controlled trial over a time horizon of 12 months. INTERVENTIONS: A self-managed, CBT-oriented exposure training for patients with panic disorder with or without agoraphobia in primary care delivered by the primary care practice team in comparison to routine care.
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