Cost-effectiveness of a primary care model for anxiety disorders

Br J Psychiatry. 2009 Oct;195(4):308-17. doi: 10.1192/bjp.bp.108.058032.


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 (euro4911 v. euro3453, P = 0.09). The probability of an incremental cost-effectiveness ratio <euro50 000 per quality-adjusted life year was below 10%.

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

Publication types

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

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anxiety Disorders / economics
  • Anxiety Disorders / therapy*
  • Cognitive Behavioral Therapy / economics*
  • Cognitive Behavioral Therapy / education
  • Cost-Benefit Analysis
  • Family Practice / economics*
  • Family Practice / education
  • Family Practice / methods
  • Germany
  • Humans
  • Middle Aged
  • Practice Guidelines as Topic
  • Primary Health Care / economics*
  • Primary Health Care / methods
  • Primary Health Care / statistics & numerical data
  • Psychiatric Status Rating Scales
  • Quality of Life
  • Referral and Consultation
  • Surveys and Questionnaires
  • Young Adult