Abstract
BackgroundSocial anxiety disorder is one of the most persistent and common anxiety disorders. Individually delivered psychological therapies are the most effective treatment options for adults with social anxiety disorder, but they are associated with high intervention costs. Therefore, the objective of this study was to assess the relative cost effectiveness of a variety of psychological and pharmacological interventions for adults with social anxiety disorder.MethodsA decision-analytic model was constructed to compare costs and quality adjusted life years (QALYs) of 28 interventions for social anxiety disorder from the perspective of the British National Health Service and personal social services. Efficacy data were derived from a systematic review and network meta-analysis. Other model input parameters were based on published literature and national sources, supplemented by expert opinion.ResultsIndividual cognitive therapy was the most cost-effective intervention for adults with social anxiety disorder, followed by generic individual cognitive behavioural therapy (CBT), phenelzine and book-based self-help without support. Other drugs, group-based psychological interventions and other individually delivered psychological interventions were less cost-effective. Results were influenced by limited evidence suggesting superiority of psychological interventions over drugs in retaining long-term effects. The analysis did not take into account side effects of drugs.ConclusionVarious forms of individually delivered CBT appear to be the most cost-effective options for the treatment of adults with social anxiety disorder. Consideration of side effects of drugs would only strengthen this conclusion, as it would improve even further the cost effectiveness of individually delivered CBT relative to phenelzine, which was the next most cost-effective option, due to the serious side effects associated with phenelzine. Further research needs to determine more accurately the long-term comparative benefits and harms of psychological and pharmacological interventions for social anxiety disorder and establish their relative cost effectiveness with greater certainty.
Highlights
Social anxiety disorder is one of the most persistent and common anxiety disorders, with a lifetime prevalence estimated to range between 3.9% and 13.7% in Europe [1]
Consideration of side effects of drugs would only strengthen this conclusion, as it would improve even further the cost effectiveness of individually delivered cognitive behavioural therapy (CBT) relative to phenelzine, which was the most costeffective option, due to the serious side effects associated with phenelzine
Given the variety of available interventions for the treatment of social anxiety disorder, the high costs associated with provision of psychological interventions, and the need for efficient use of healthcare resources under conditions of restricted budgets, the objective of this study was to examine the cost-effectiveness of a wide range of psychological and pharmacological interventions for the treatment of adults with social anxiety disorder from the perspective of the British National Health Service (NHS) and Personal Social Services, using decision-analytic modelling
Summary
Social anxiety disorder is one of the most persistent and common anxiety disorders, with a lifetime prevalence estimated to range between 3.9% and 13.7% in Europe [1]. People with social anxiety disorder have difficulty forming and retaining personal and social relationships [2], have higher risk of leaving school early and obtaining poorer qualifications [3], experience impairment in their daily functioning including work/school performance and social life [4], and report an important reduction in their quality of life compared with people without the disorder [5] They incur considerable healthcare costs, especially relating to the use of primary care services, experience high levels of productivity losses and receive higher social benefits compared with people in the general population [6,7,8]. The objective of this study was to assess the relative cost effectiveness of a variety of psychological and pharmacological interventions for adults with social anxiety disorder
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