Cost-effectiveness and Cost Offset of a Collaborative Care Intervention for Primary Care Patients With Panic Disorder | Psychiatry and Behavioral Health | JAMA Psychiatry | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 35.170.64.36. Please contact the publisher to request reinstatement.
1.
Spitzer  RLWilliams  JBKroenke  KLinzer  MDeGruy  FV  IIIHahn  SRBrody  DJohnson  JG Utility of a new procedure for diagnosing mental disorders in primary care: the PRIME-MD 1000 study.  JAMA. 1994;2721749- 1756Google ScholarCrossref
2.
Simon  GE Psychiatric disorder and functional somatic symptoms as predictors of health care use.  Psychiatr Med. 1992;1049- 59Google Scholar
3.
Katon  WVon Korff  MLin  ELipscomb  PRusso  JWagner  EPolk  E Distressed high utilizers of medical care: DSM-III-R diagnoses and treatment needs.  Gen Hosp Psychiatry. 1990;12355- 362Google ScholarCrossref
4.
Katon  WHall  MLRusso  JCormier  LHollifield  MVitaliano  PPBeitman  BD Chest pain: relationship of psychiatric illness to coronary arteriographic results.  Am J Med. 1988;841- 9Google ScholarCrossref
5.
Simon  GEVon Korff  M Somatization and psychiatric disorder in the NIMH Epidemiologic Catchment Area Study.  Am J Psychiatry. 1991;1481494- 1500Google Scholar
6.
Barsky  AJClear  PDCoeytaux  RRRuskin  JN Psychiatric disorders in medical outpatients complaining of palpitations.  J Gen Intern Med. 1994;9306- 313Google ScholarCrossref
7.
Sherbourne  CWells  KJudd  L Functioning and well-being of patients with panic disorder.  Am J Psychiatry. 1996;153213- 218Google Scholar
8.
Kouzis  AEaton  W Psychopathology and the initiation of disability payments.  Psychiatr Serv. 2000;51908- 913Google ScholarCrossref
9.
Roy-Byrne  PPStein  MBRusso  JMercier  EThomas  RMcQuaid  JKaton  WJCraske  MGBystritsky  ASherbourne  CD Panic disorder in the primary care setting: comorbidity, disability service utilization, and treatment.  J Clin Psychiatry. 1999;60492- 499Google ScholarCrossref
10.
Meredith  LSSherbourne  CDJackson  CACamp  PWells  KB Treatment typically provided for comorbid anxiety disorder.  Arch Fam Med. 1997;6231- 237Google ScholarCrossref
11.
Roy-Byrne  PKaton  WCowley  DRusso  J A randomized effectiveness trial of an intervention for panic disorder in primary care.  Arch Gen Psychiatry. 2001;58869- 876Google ScholarCrossref
12.
Von Korff  MKaton  WBush  TLin  EHSimon  GESaunders  KLudman  EWalker  EUnützer  J Treatment costs, cost offset, and cost-effectiveness of collaborative management of depression.  Psychosom Med. 1998;60143- 149Google ScholarCrossref
13.
Simon  GKaton  WVon Korff  MUnützer  JLin  EHBWalker  EBush  TRutter  CLudman  E Cost-effectiveness of a collaborative care program for primary care patients with persistent depression.  Am J Psychiatry. 2001;1581638- 1644Google ScholarCrossref
14.
Stein  MBRoy-Byrne  PPMcQuaid  JRLaffaye  CRusso  JMcCahill  MEKaton  WCraske  MBystritsky  ASherbourne  CD Development of a brief diagnostic screen for panic disorder in primary care.  Psychosom Med. 1999;61359- 364Google ScholarCrossref
15.
Roy-Byrne  PStein  MBystrisky  AKaton  W Pharmacotherapy of panic disorder: proposed guidelines for the family physician.  J Am Board Fam Pract. 1998;11282- 290Google ScholarCrossref
16.
Katon  WVon Korff  MLin  EWalker  ESimon  GBush  TRobinson  PRusso  J Collaborative management to achieve treatment guidelines: impact on depression in primary care.  JAMA. 1995;2731026- 1031Google ScholarCrossref
17.
Katon  WRobinson  PVon Korff  MLin  EBush  TLudman  ESimon  GWalker  E A multifaceted intervention to improve treatment of depression in primary care.  Arch Gen Psychiatry. 1996;53924- 932Google ScholarCrossref
18.
World Health Organization, Composite International Diagnostic Interview (CIDI)2.1.  Geneva, Switzerland World Health Organization1997;
19.
Blazer  DKessler  RMcGonagle  KSwarz  M The prevalence and distribution of major depression in a national community sample: the National Comorbidity Survey.  Am J Psychiatry. 1994;151979- 986Google Scholar
20.
Wittchen  HUKessler  RZhao  S Reliability and clinical validity of UM-CIDI DSM-III-R generalized anxiety disorder.  J Psychiatr Res. 1995;2995- 110Google ScholarCrossref
21.
Wittchen  HUKessler  RAbelson  J Reliability and procedural validity of UM-CIDI DSM-III-R phobic disorders.  Psychol Med. 1996;251169- 1177Google ScholarCrossref
22.
Wells  KBurnam  MLeake  B Agreement between face-to-face and telephone-administered versions of the depression section of the NIMH Diagnostic Interview Schedule.  J Psychiatr Res. 1988;22207- 220Google ScholarCrossref
23.
Peterson  RAReiss  S Anxiety Sensitivity Index Test Manual. 2nd Worthington, Ohio International Diagnostic Systems1992;
24.
Otto  MWReilly-Harrington  NA The impact of anxiety sensitivity. Taylor  Sed Anxiety Sensitivity: Theory, Research and Treatment of the Fear of Anxiety Hillsdale, NJ LawrenceA Erlbaum Associates1999;321- 336Google Scholar
25.
Hazen  AWalker  EEldridge  G Anxiety sensitivity and treatment outcome in panic disorder.  Anxiety. 1996;234- 39Google ScholarCrossref
26.
Shear  MKMaser  JD Standardized assessment for panic disorder research: a conference report.  Arch Gen Psychiatry. 1994;51346- 354Google ScholarCrossref
27.
Miller  MDParadis  CFHouck  PRMazumdar  SStack  JARifai  AHMulsant  BReynolds  CF  III Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale.  Psychiatry Res. 1992;41237- 248Google ScholarCrossref
28.
Wells  K The design of Partners in Care: evaluating the cost-effectiveness of improving care for depression in primary care.  Soc Psychiatry Psychiatr Epidemiol. 1999;3420- 29Google ScholarCrossref
29.
 RBRVS EZ-Fees, 2000.  Milwaukee, Wis Wasserman Medical Publishers Ltd2000;
30.
Lave  JFrank  RSchulberg  HKamlet  M Cost-effectiveness of treatments for major depression in primary care practice.  Arch Gen Psychiatry. 1998;55645- 651Google ScholarCrossref
31.
Blough  DMadden  CHorinbrook  M Modeling risk using generalized linear models.  J Health Econ. 1999;18153- 171Google ScholarCrossref
32.
Pollack  SBruce  PBornstein  MLieberman  J The resampling method of statistical analysis.  Psychopharmacol Bull. 1994;30227- 234Google Scholar
33.
Manning  WFryback  DWeinstein  M Deflecting uncertainty in cost effectiveness analysis. Gold  MSiegel  JRussel  LWeinstein  Meds Cost-effectiveness in Health and Medicine New York, NY Oxford University Press Inc1996;Google Scholar
34.
Simon  GManning  WKatzelnick  DPearson  SHenk  HHeestand  C Cost-effectiveness of systemic depression treatment for high utilizers of primary care.  Arch Gen Psychiatry. 2001;58181- 187Google ScholarCrossref
35.
Katon  W Panic disorder: relationship to high medical utilization, unexplained physical symptoms, and medical costs.  J Clin Psychiatry. 1996;57suppl 1011- 18Google Scholar
36.
Barsky  ACleary  PCoeytaux  RRuskin  J Psychiatric disorders in medical outpatients complaining of palpitations.  J Gen Intern Med. 1994;9306- 313Google ScholarCrossref
37.
Walker  EGelfand  AGelfand  MKaton  W Psychiatric diagnoses, sexual and physical victimization and disability in patients with irritable bowel syndrome and inflammatory bowel disease.  Psychol Med. 1995;251259- 1267Google ScholarCrossref
38.
Fogarty  JEngel  C  JrRusso  JSimon  GKaton  W Hypertension and pheochromocytoma testing: the association with anxiety disorders.  Arch Fam Med. 1994;355- 60Google Scholar
39.
Stein  MAsmundson  GIreland  DWalker  J Panic disorder in patients attending a clinic for vestibular disorders.  Am J Psychiatry. 1994;1511697- 1700Google Scholar
40.
Klerman  GWeissman  MOuellette  RJohnson  JGreenwald  S Panic attacks in the community: social morbidity and health care utilization.  JAMA. 1991;265742- 746Google ScholarCrossref
41.
Markowitz  JWeissman  MOuellette  RLish  JKlerman  G Quality of life in panic disorder.  Arch Gen Psychiatry. 1989;46984- 992Google ScholarCrossref
42.
Mendlowicz  MStein  M Quality of life in individuals with anxiety disorders.  Am J Psychiatry. 2000;157669- 682Google ScholarCrossref
43.
Katon  WHollifiled  MChapman  TMannuza  SBallengar  JFyer  A Infrequent panic attacks: psychiatric comorbidity, personality characteristics and functional disability.  J Psychiatry Res. 1995;29121- 131Google ScholarCrossref
44.
Salvador-Carulla  LSequi  JFernandez-Cato  PCanet  J Costs and offset effect in panic disorders.  Br J Psychiatry Suppl. 1995; (27) 23- 28Google Scholar
45.
Schoenbaum  MUnützer  JSherbourne  CDuan  NRubinstein  LMiranda  JMeredith  LSCarney  MFWells  K Cost-effectiveness of practice-initiated quality improvement for depression: results of a randomized controlled trial.  JAMA. 2001;2861325- 1330Google ScholarCrossref
Original Article
December 2002

Cost-effectiveness and Cost Offset of a Collaborative Care Intervention for Primary Care Patients With Panic Disorder

Author Affiliations

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.

Arch Gen Psychiatry. 2002;59(12):1098-1104. doi:10.1001/archpsyc.59.12.1098
Abstract

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 approximately2 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.

×