This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (50)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Patient Education/ Health Literacy  • Panic Disorder  • Alert me on articles by topic

Wayne J. Katon, MD; Peter Roy-Byrne, MD; Joan Russo, PhD; Deborah Cowley, MD

Arch Gen Psychiatry. 2002;59:1098-1104.

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.

From the Departments of Psychiatry and Behavioral Sciences, University of Washington Medical School (Drs Katon, Russo, and Cowley) and Harborview Medical Center (Dr Roy-Byrne), Seattle, Wash.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Best Practices: Integrating Behavioral Health and Primary Care: The Harris County Community Behavioral Health Program
Begley et al.
Psychiatr. Serv. 2008;59:356-358.
ABSTRACT | FULL TEXT  

A Critical Analysis of Approaches to Targeted PTSD Prevention: Current Status and Theoretically Derived Future Directions
Feldner et al.
Behav Modif 2007;31:80-116.
ABSTRACT  

Treatment and Adequacy of Treatment of Mental Disorders Among Respondents to the Mexico National Comorbidity Survey
Borges et al.
Am. J. Psychiatry 2006;163:1371-1378.
ABSTRACT | FULL TEXT  

Cost-Effectiveness of a Primary Care Treatment Program for Depression in Low-Income Women in Santiago, Chile
Araya et al.
Am. J. Psychiatry 2006;163:1379-1387.
ABSTRACT | FULL TEXT  

Panic-prone state induced in rats with GABA dysfunction in the dorsomedial hypothalamus is mediated by NMDA receptors.
Johnson and Shekhar
J. Neurosci. 2006;26:7093-7104.
ABSTRACT | FULL TEXT  

Clinical practice. Panic disorder.
Katon
NEJM 2006;354:2360-2367.
FULL TEXT  

Antidepressant Adherence and Medical Resource Use Among Managed Care Patients With Anxiety Disorders
Stein et al.
Psychiatr. Serv. 2006;57:673-680.
ABSTRACT | FULL TEXT  

Transforming Mental Health Care at the Interface With General Medicine: Report for the Presidents Commission
Unutzer et al.
Psychiatr. Serv. 2006;57:37-47.
ABSTRACT | FULL TEXT  

A Randomized Trial to Improve the Quality of Treatment for Panic and Generalized Anxiety Disorders in Primary Care
Rollman et al.
Arch Gen Psychiatry 2005;62:1332-1341.
ABSTRACT | FULL TEXT  

Twelve-Month Use of Mental Health Services in the United States: Results From the National Comorbidity Survey Replication
Wang et al.
Arch Gen Psychiatry 2005;62:629-640.
ABSTRACT | FULL TEXT  

Integrating Psychologic Approaches Into the Behavioral Management of Cardiac Patients
Rozanski
Psychosom. Med. 2005;67:S67-S73.
ABSTRACT | FULL TEXT  

The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: The emerging field of behavioral cardiology
Rozanski et al.
J Am Coll Cardiol 2005;45:637-651.
ABSTRACT | FULL TEXT  

A Randomized Effectiveness Trial of Cognitive-Behavioral Therapy and Medication for Primary Care Panic Disorder
Roy-Byrne et al.
Arch Gen Psychiatry 2005;62:290-298.
ABSTRACT | FULL TEXT  

RCT of a Care Manager Intervention for Major Depression in Primary Care: 2-Year Costs for Patients With Physical vs Psychological Complaints
Dickinson et al.
Ann Fam Med 2005;3:15-22.
ABSTRACT | FULL TEXT  

A Randomized Effectiveness Trial of Stepped Collaborative Care for Acutely Injured Trauma Survivors
Zatzick et al.
Arch Gen Psychiatry 2004;61:498-506.
ABSTRACT | FULL TEXT  

Best Practices: Are Financial Incentives and Best Practices Compatible?
Dickey
Psychiatr. Serv. 2004;55:130-131.
FULL TEXT  

Collaborative care involving pharmacotherapy was cost effective for increasing anxiety free days in panic disorder
Barbui and Patten
Evid. Based Med. 2003;8:126-126.
FULL TEXT  

OTHER ARTICLES NOTED (24 Jan 03 to 18 Apr 03)
Evid. Based Nurs. 2003;6:e1-12.
FULL TEXT