Cost-Efficacy of Individual and Combined Treatments for Panic Disorder

R. Kathryn McHugh, M.A.; Michael W. Otto, Ph.D.; David H. Barlow, Ph.D.; Jack M. Gorman, M.D.;
 M. Katherine Shear, M.D.; and Scott W. Woods, M.D.

Objective: The objective of this study was to examine the relative cost-efficacy of empirically supported treatments for panic disorder. As psychosocial, pharmacologic, and combined treatments have all demonstrated efficacy in the treatment of panic disorder, cost-efficacy analysis provides an additional source of information to guide clinical decision making.

Method: Cost-efficacy was examined based on results from the Multicenter Comparative Treatment Study of Panic Disorder, a randomized controlled trial of treatment for panic disorder (DSM-III-R). The trial was conducted from May 1991 to April 1998. Cost-efficacy ratios representing the cost per 1-unit improvement in Panic Disorder Severity Scale mean item score were calculated for 3 monotherapies (cognitive-behavioral therapy [CBT], imipramine, and paroxetine) and 2 combination treatments (CBT-imipramine and CBT-paroxetine) at the end of acute, maintenance, and follow-up phases.

Results: Results demonstrated consistently greater cost-efficacy for individual over combined treatments, with imipramine representing the most cost-efficacious treatment option at the completion of the acute phase (cost-efficacy ratio = $972) and CBT representing the most cost-efficacious option at the end of maintenance treatment (cost efficacy ratio = $1449) and 6 months after treatment termination (cost-efficacy ratio = $1227).

Conclusion: In the context of similar efficacy for combined treatments, but poorer cost-efficacy, current monotherapies should be considered the first-line treatment of choice for panic disorder. Additionally, CBT emerged as the most durable and cost-effective monotherapy and, hence, should be considered as a particularly valuable treatment from the perspective of cost accountability.

(J Clin Psychiatry 2007;68:1038-1044)

Received Aug. 4, 2006; accepted Nov. 16, 2006. From the Department of Psychology, Center for Anxiety and Related Disorders, Boston University, Boston, Mass. (Drs. Otto and Barlow and Ms. McHugh); Department of Psychiatry, Mount Sinai School of Medicine, New York, N.Y. (Dr. Gorman); the Department of Psychiatry, Columbia University School of Social Work, New York, N.Y. (Dr. Shear); and the Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Dr. Woods).

This article was supported in part by National Institute of Mental Health grants R01MH45965 (Dr. Barlow), R01MH45964 (Dr. Gorman), R01MH45963 (Dr. Shear), and R01MH45966 (Dr. Woods).

In the last year, Dr. Otto has served as a consultant for Sanofi-Aventis and Organon. Dr. Shear has served as a consultant for Pfizer and has received research funding from Forest. Drs. Barlow, Gorman, and Woods and Ms. McHugh report no additional financial or other relationships relevant to the subject of this article.

Corresponding author and reprints: R. Kathryn McHugh, M.A., Center for Anxiety and Related Disorders, Boston University, 648 Beacon St., 6th Floor, Boston, MA 02215 (e-mail: rkmchugh@bu.edu).