TY - JOUR
KW - Adult
KW - Ambulatory Care/economics
KW - Combined Modality Therapy
KW - Cost-Benefit Analysis/statistics & numerical data
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Panic Disorder/diagnosis/drug therapy/economics
KW - Paroxetine/administration & dosage/adverse effects/economics
KW - Patient Care Team/economics
KW - Patient Education as Topic/economics
KW - Primary Health Care/economics
KW - Psychiatry/economics
KW - Psychotherapy/economics
KW - Referral and Consultation/economics
KW - Serotonin Uptake Inhibitors/administration & dosage/adverse effects/economics
KW - Treatment Outcome
KW - Washington
AU - W. J. Katon
AU - P. Roy-Byrne
AU - J. Russo
AU - D. Cowley
A1 - 
AB - BACKGROUND: A collaborative care (CC) intervention for patients with panic disorder that provided increased patient education and integrated a psychiatrist into primary care was associated with improved symptomatic and functional outcomes. This report evaluates the incremental cost-effectiveness and potential cost offset of a CC treatment program for primary care patients with panic disorder from the perspective of the payer. METHODS: We randomly assigned 115 primary care patients with panic disorder to a CC intervention that included systematic patient education and approximately 2 visits with an on-site consulting psychiatrist, compared with usual primary care. Telephone assessments of clinical outcomes were performed at 3, 6, 9, and 12 months. Use of health care services and costs were assessed using administrative data from the primary care clinics and self-report data. RESULTS: Patients receiving CC experienced a mean of 74.2 more anxiety-free days during the 12-month intervention (95% confidence interval [CI], 15.8-122.0). The incremental mental health cost of the CC intervention was $205 (95% CI, -$135 to $501), with the additional mental health costs of the intervention explained by expenditures for antidepressant medication and outpatient mental health visits. Total outpatient cost was $325 (95% CI, -$1460 to $448) less for the CC than for the usual care group. The incremental cost-effectiveness ratio for total ambulatory cost was -$4 (95% CI, -$23 to $14) per anxiety-free day. Results of a bootstrap analysis suggested a 0.70 probability that the CC intervention was dominant (eg, lower costs and greater effectiveness). CONCLUSION: A CC intervention for patients with panic disorder was associated with significantly more anxiety-free days, no significant differences in total outpatient costs, and a distribution of the cost-effectiveness ratio based on total outpatient costs that suggests a 70% probability that the intervention was dominant, compared with usual care.
BT - Archives of General Psychiatry
C5 - Financing & Sustainability
CP - 12
CY - United States
DO - 10.2337/diacare.29.02.06.dc05-1572
IS - 12
JF - Archives of General Psychiatry
N2 - BACKGROUND: A collaborative care (CC) intervention for patients with panic disorder that provided increased patient education and integrated a psychiatrist into primary care was associated with improved symptomatic and functional outcomes. This report evaluates the incremental cost-effectiveness and potential cost offset of a CC treatment program for primary care patients with panic disorder from the perspective of the payer. METHODS: We randomly assigned 115 primary care patients with panic disorder to a CC intervention that included systematic patient education and approximately 2 visits with an on-site consulting psychiatrist, compared with usual primary care. Telephone assessments of clinical outcomes were performed at 3, 6, 9, and 12 months. Use of health care services and costs were assessed using administrative data from the primary care clinics and self-report data. RESULTS: Patients receiving CC experienced a mean of 74.2 more anxiety-free days during the 12-month intervention (95% confidence interval [CI], 15.8-122.0). The incremental mental health cost of the CC intervention was $205 (95% CI, -$135 to $501), with the additional mental health costs of the intervention explained by expenditures for antidepressant medication and outpatient mental health visits. Total outpatient cost was $325 (95% CI, -$1460 to $448) less for the CC than for the usual care group. The incremental cost-effectiveness ratio for total ambulatory cost was -$4 (95% CI, -$23 to $14) per anxiety-free day. Results of a bootstrap analysis suggested a 0.70 probability that the CC intervention was dominant (eg, lower costs and greater effectiveness). CONCLUSION: A CC intervention for patients with panic disorder was associated with significantly more anxiety-free days, no significant differences in total outpatient costs, and a distribution of the cost-effectiveness ratio based on total outpatient costs that suggests a 70% probability that the intervention was dominant, compared with usual care.
PP - United States
PY - 2002
SN - 0003-990X; 0003-990X
SP - 1098
EP - 1104
EP - 
T1 - Cost-effectiveness and cost offset of a collaborative care intervention for primary care patients with panic disorder
T2 - Archives of General Psychiatry
TI - Cost-effectiveness and cost offset of a collaborative care intervention for primary care patients with panic disorder
U1 - Financing & Sustainability
U2 - 12470125
U3 - 10.2337/diacare.29.02.06.dc05-1572
VL - 59
VO - 0003-990X; 0003-990X
Y1 - 2002
ER -