Nina Egger1, Alexander Konnopka1, Manfred E Beutel2, Stephan Herpertz3, Wolfgang Hiller2, Juergen Hoyer4, Simone Salzer5, Ulrich Stangier6, Bernhard Strauss7, Ulrike Willutzki8, Joerg Wiltink2, Eric Leibing5, Falk Leichsenring9, Hans-Helmut König1. 1. Department of Health Economics and Health Services Research, Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 2. Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany. 3. Department of Psychosomatic Medicine and Psychotherapy, LWL University Clinic Bochum, Ruhr-University Bochum, Bochum, Germany. 4. Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany. 5. Department of Psychosomatic Medicine and Psychotherapy, University Medicine, Georg-August-University, Goettingen, Germany. 6. Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany. 7. Institute of Psychosocial Medicine and Psychotherapy, University Hospital Jena, Jena, Germany. 8. Clinical Psychology and Psychotherapy, University Witten/Herdecke, Witten, Germany. 9. Clinic of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany.
Abstract
BACKGROUND: To determine the cost-effectiveness of cognitive behavioral therapy (CBT) versus psychodynamic therapy (PDT) in the treatment of social anxiety disorder after a follow-up of 30 months from a societal perspective. METHODS: This analysis was conducted alongside the multicenter SOPHO-NET trial; adults with a primary diagnosis of social anxiety disorder received CBT (n = 209) or PDT (n = 207). Data on health care utilization and productivity loss were collected at baseline, after 6 months (posttreatment), and three further follow-ups to calculate direct and indirect costs. Anxiety-free days (AFDs) calculated based on remission and response were used as measure of effect. The incremental cost-effectiveness ratio (ICER) was determined. Net benefit regressions, adjusted for comorbidities and baseline differences, were applied to derive cost-effectiveness acceptability curves. RESULTS: In the descriptive analysis, the unadjusted ICER favored CBT over PDT and the adjusted analysis showed that CBT's cost-effectiveness relative to PDT depends on the willingness to pay (WTP) per AFD. As baseline costs differed substantially the unadjusted estimates might be deceptive. If additional WTPs for CBT of €0, €10, and €30 were assumed, the probability of CBT being cost-effective relative to PDT was 65, 83, and 96%. Direct costs increased compared to baseline across groups, whereas indirect costs did not change significantly. Results were sensitive to considered costs. CONCLUSIONS: If the society is willing to pay ≥€30 per additional AFD, CBT can be considered cost-effective, relative to PDT, with certainty. To further increase the cost-effectiveness more knowledge regarding predictors of treatment outcome seems essential.
BACKGROUND: To determine the cost-effectiveness of cognitive behavioral therapy (CBT) versus psychodynamic therapy (PDT) in the treatment of social anxiety disorder after a follow-up of 30 months from a societal perspective. METHODS: This analysis was conducted alongside the multicenter SOPHO-NET trial; adults with a primary diagnosis of social anxiety disorder received CBT (n = 209) or PDT (n = 207). Data on health care utilization and productivity loss were collected at baseline, after 6 months (posttreatment), and three further follow-ups to calculate direct and indirect costs. Anxiety-free days (AFDs) calculated based on remission and response were used as measure of effect. The incremental cost-effectiveness ratio (ICER) was determined. Net benefit regressions, adjusted for comorbidities and baseline differences, were applied to derive cost-effectiveness acceptability curves. RESULTS: In the descriptive analysis, the unadjusted ICER favored CBT over PDT and the adjusted analysis showed that CBT's cost-effectiveness relative to PDT depends on the willingness to pay (WTP) per AFD. As baseline costs differed substantially the unadjusted estimates might be deceptive. If additional WTPs for CBT of €0, €10, and €30 were assumed, the probability of CBT being cost-effective relative to PDT was 65, 83, and 96%. Direct costs increased compared to baseline across groups, whereas indirect costs did not change significantly. Results were sensitive to considered costs. CONCLUSIONS: If the society is willing to pay ≥€30 per additional AFD, CBT can be considered cost-effective, relative to PDT, with certainty. To further increase the cost-effectiveness more knowledge regarding predictors of treatment outcome seems essential.
Authors: Frances L Lynch; John F Dickerson; Michelle S Rozenman; Araceli Gonzalez; Karen T G Schwartz; Giovanna Porta; Maureen O'Keeffe-Rosetti; David Brent; V Robin Weersing Journal: JAMA Netw Open Date: 2021-03-01