Cost-effectiveness of psychological and pharmacological interventions for generalized anxiety disorder and panic disorder

Heuzenroeder, Louise, Donnelly, Marie, Haby, Michelle M., Mihalopoulos, Cathy, Rossell, Ruth, Carter, Rob, Andrews, Gavin and Vos, Theo 2004, Cost-effectiveness of psychological and pharmacological interventions for generalized anxiety disorder and panic disorder, Australian and New Zealand journal of psychiatry, vol. 38, no. 8, pp. 602-612, doi: 10.1111/j.1440-1614.2004.01423.x.

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Title Cost-effectiveness of psychological and pharmacological interventions for generalized anxiety disorder and panic disorder
Author(s) Heuzenroeder, Louise
Donnelly, Marie
Haby, Michelle M.
Mihalopoulos, CathyORCID iD for Mihalopoulos, Cathy
Rossell, Ruth
Carter, RobORCID iD for Carter, Rob
Andrews, Gavin
Vos, Theo
Journal name Australian and New Zealand journal of psychiatry
Volume number 38
Issue number 8
Start page 602
End page 612
Publisher Taylor & Francis Ltd.
Place of publication Carlton, Vic.
Publication date 2004
ISSN 0004-8674
Summary Objective: To assess from a health sector perspective the incremental cost-effectiveness of interventions for generalized anxiety disorder (cognitive behavioural therapy [CBT] and serotonin and noradrenaline reuptake inhibitors [SNRIs]) and panic disorder (CBT, selective serotonin reuptake inhibitors [SSRIs] and tricyclic antidepressants [TCAs]).

Method: The health benefit is measured as a reduction in disability-adjusted life years (DALYs), based on effect size calculations from meta-analyses of randomised controlled trials. An assessment on second stage filters ('equity', 'strength of evidence', 'feasibility' and 'acceptability to stakeholders') is also undertaken to incorporate additional factors that impact on resource allocation decisions. Costs and benefits are calculated for a period of one year for the eligible population (prevalent cases of generalized anxiety disorder/panic disorder identified in the National Survey of Mental Health and Wellbeing, extrapolated to the Australian population in the year 2000 for those aged 18 years and older). Simulation modelling techniques are used to present 95% uncertainty intervals (UI) around the incremental cost-effectiveness ratios (ICERs).

Results: Compared to current practice, CBT by a psychologist on a public salary is the most cost-effective intervention for both generalized anxiety disorder (A$6900/DALY saved; 95% UI A$4000 to A$12 000) and panic disorder (A$6800/DALY saved; 95% UI A$2900 to A$15 000). Cognitive behavioural therapy results in a greater total health benefit than the drug interventions for both anxiety disorders, although equity and feasibility concerns for CBT interventions are also greater.

Conclusions: Cognitive behavioural therapy is the most effective and cost-effective intervention for generalized anxiety disorder and panic disorder. However, its implementation would require policy change to enable more widespread access to a sufficient number of trained therapists for the treatment of anxiety disorders.
Notes Published Online: 5 Aug 2004
Language eng
DOI 10.1111/j.1440-1614.2004.01423.x
Field of Research 140208 Health Economics
Socio Economic Objective 970114 Expanding Knowledge in Economics
HERDC Research category C1.1 Refereed article in a scholarly journal
Copyright notice ©2004, Taylor & Francis
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Document type: Journal Article
Collections: Faculty of Health
School of Health and Social Development
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