Cost-effectiveness and Cost Offset of a Collaborative Care Intervention for Primary Care Patients with Panic Disorder
Katon WJ, Roy-Byrne PP, Russo J, Cowley DS;
Commented by , 29 Jan 2003
Also: "A Randomized Effectiveness Trial of Collaborative Care for Patients with Panic Disorder in Primary Care", Archives of General Psychiatry 2001; 58; 869-876
Aim of the study
The present study (published in two issues of the Archives of General Psychiatry) tested the clinical effectiveness as well as the cost-effectiveness and cost offset in a trial combining psychiatrist-guided pharmacotherapy, patient education and disease management.
Method
115 patients meeting DSM-IV diagnostic criteria for PD were recruited in three primary care clinics. Psychiatric and physical co-morbidities were accepted except those that were potentially life-threatening or that would have limited patient adherence to the protocol.
Patients were randomly assigned to the trial programme - termed “collaborative care” (CC) - or to usual care (UC). CC patients received two visits and two telephone calls in the first eight weeks (plus up to five telephone calls between three and 12 months’ follow-up) by a psychiatrist, pharmacotherapy (prescribed and adjusted by a psychiatrist) with a selective serotonin reuptake inhibitor, and an educational videotape and pamphlet about the nature of PD, the medication and its adverse effects. UC patients received treatment as usual from their primary care physician.
Patients were assessed before the onset of the trial and at three-month intervals by graduate psychologist telephone interviewers.
The use of health care services and costs were assessed using administrative data from the primary care clinics as well as self-report data concerning the use of outside providers.
Results
Quality of care with respect to medication (appropriate type of medication, adequate dosage and duration, adherence to medication) was significantly higher in the CC group than in the UC group. Clinical (anxiety and depression) and functional (disability) outcomes were significantly better in the CC group than in the UC group.
Patients in CC had significantly more anxiety-free days and total outpatient costs for the CC intervention were less than those for UC.
Discussion
Panic disorder (PD) is a prevalent and severe anxiety disorder. It is associated with a high degree of distress, use of medical services and disablement. It is frequently encountered and treated in primary care, but is often not recognized and/or treated inadequately.
The present study suggests that limited psychiatrist-guided interventions (2 visits, psychoeducation, and decisions about pharmacotherapy) can significantly improve the treatment effectiveness.
The most striking finding of the study is that such interventions are not necessarily associated with an increase in costs, but that they may in fact reduce the total financial burden that is associated with the disorder.
The study presents several limitations. In particular, the authors did not consider the effect of anxiety on absences of work, loss of productivity, or interpersonal (including marital or family) relationships. In fact, had these factors be considered, the value of the CC intervention would probably have been even higher.