Incremental Cost-effectiveness of Pharmacotherapy and Two Brief Cognitive-Behavioral Therapies Compared With Usual Care for Panic Disorder and Noncardiac Chest Pain
and §Family Medicine Department, Université de Sherbrooke, Sherbrooke, Quebec, Canada.The Journal of nervous and mental disease (Impact Factor: 1.69). 09/2013; 201(9):753-9. DOI: 10.1097/NMD.0b013e3182a2127d
The aim of this study was to assess the incremental cost-effectiveness ratios (ICERs) of two brief cognitive-behavioral therapy (CBT)-based interventions and a pharmacological treatment, compared with usual care, initiated in the emergency department (ED) for individuals with panic disorder (PD) with a chief complaint of noncardiac chest pain. A total of 69 patients were followed up to 6 months. The primary outcome variables were direct and indirect costs of treatment and PD severity. Panic management (PM) had an ICER of $124.05, per the Anxiety Disorders Interview Schedule for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, severity score change (95% confidence interval [CI], $54.63-$314.57), compared with pharmacotherapy (paroxetine), with an ICER of $213.90 (95% CI, $133.51-$394.94), and brief CBT, with an ICER of $309.31 (95% CI, $151.27-$548.28). The pharmacological and CBT interventions were associated with a greater clinical improvement compared with usual care at posttest. PM presented a superior ICER, suggesting that it may be a promising treatment option to implement in EDs.