The British Journal of Psychiatry (2009) 195: 308-317. doi: 10.1192/bjp.bp.108.058032
© 2009 The Royal College of Psychiatrists
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Cost-effectiveness of a primary care model for anxiety disorders

Hans-Helmut König, MD, MPH

Health Economics Research Unit, Department of Psychiatry

Anja Born, MSc

Health Economics Research Unit, Department of Psychiatry, and Department of Medical Psychology and Medical Sociology

Dirk Heider, MSc

Health Economics Research Unit, Department of Psychiatry

Herbert Matschinger, PhD

Department of Psychiatry

Sven Heinrich, MSc

Health Economics Research Unit, Department of Psychiatry

Steffi G. Riedel-Heller, MD, MPH

Public Health Research Unit, Department of Psychiatry

Daniel Surall, MSc

Department of Psychiatry, University of Leipzig, Germany

Matthias C. Angermeyer, MD

Center for Public Mental Health, Gösing am Wagram, Austria

Christiane Roick, MD, MPH

Health Economics Research Unit, Department of Psychiatry, University of Leipzig, Germany

Correspondence: Hans-Helmut König, MPH, University of Leipzig, Health Economics Research Unit, Department of Psychiatry, Liebigstr. 26, D-04103 Leipzig, Germany. Email: hans-helmut.koenig{at}medizin.uni-leipzig.de

Declaration of interest

None.

Background

Individuals with anxiety disorders often do not receive an accurate diagnosis or adequate treatment in primary care.

Aims

To analyse the cost-effectiveness of an optimised care model for people with anxiety disorders in primary care.

Method

In a cluster randomised controlled trial, 46 primary care practices with 389 individuals positively screened with anxiety were randomised to intervention (23 practices, 201 participants) or usual care (23 practices, 188 participants). Physicians in the intervention group received training on diagnosis and treatment of anxiety disorders combined with the offer of a psychiatric consultation–liaison service for 6 months. Anxiety, depression, quality of life, service utilisation and costs were assessed at baseline, 6-month and 9-month follow-up.

Results

No significant differences were observed between intervention and control group on the Beck Anxiety Inventory, Beck Depression Inventory and EQ–5D during follow-up. Total costs were higher in the intervention group ({euro}4911 v. {euro}3453, P = 0.09). The probability of an incremental cost-effectiveness ratio <{euro}50 000 per quality-adjusted life year was below 10%.

Conclusions

The optimised care model did not prove to be cost-effective.


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