The cost-effectiveness of psychotherapy and paroxetine for severe irritable bowel syndrome

Gastroenterology. 2003 Feb;124(2):303-17. doi: 10.1053/gast.2003.50055.


Background & aims: Psychotherapy and antidepressants are effective in patients with severe irritable bowel syndrome (IBS), but the cost-effectiveness of either treatment in routine practice has not been established.

Methods: Patients with severe IBS were randomly allocated to receive 8 sessions of individual psychotherapy, 20 mg daily of the specific serotonin reuptake inhibitor (SSRI) antidepressant, paroxetine, or routine care by a gastroenterologist and general practitioner. Primary outcome measures of abdominal pain, health-related quality of life, and health care costs were determined after 3 months of treatment and 1 year later.

Results: A total of 257 subjects (81% response rate) from 7 hospitals were recruited; 59 of 85 patients (69%) randomized to psychotherapy and 43 of 86 (50%) of the paroxetine group completed the full course of treatment. Both psychotherapy and paroxetine were superior to treatment as usual in improving the physical aspects of health-related quality of life (SF-36 physical component score improvement, 5.2 [SEM, 1.26], 5.8 [SEM, 1.0], and -0.3 [SEM, 1.17]; P < 0.001), but there was no difference in the psychological component. During the follow-up year, psychotherapy but not paroxetine was associated with a significant reduction in health care costs compared with treatment as usual (psychotherapy, $976 [SD, $984]; paroxetine, $1252 [SD, $1616]; and treatment as usual, $1663 [SD, $3177]).

Conclusions: For patients with severe IBS, both psychotherapy and paroxetine improve health-related quality of life at no additional cost.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absenteeism
  • Adult
  • Antidepressive Agents, Second-Generation / therapeutic use*
  • Colonic Diseases, Functional / physiopathology*
  • Colonic Diseases, Functional / therapy*
  • Cost-Benefit Analysis
  • Female
  • Forecasting
  • Health Care Costs*
  • Health Status
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Pain / physiopathology
  • Paroxetine / economics*
  • Paroxetine / therapeutic use*
  • Patient Compliance
  • Psychotherapy / economics*
  • Quality of Life
  • Severity of Illness Index
  • Treatment Outcome


  • Antidepressive Agents, Second-Generation
  • Paroxetine