Article Abstract

Online ISSN: 1099-176X    Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 20, Issue 1, 2017. Pages: 11-20
Published Online: 1 March 2017

Copyright © 2017 ICMPE.

Reduction in Costs after Treating Comorbid Panic Disorder with Agoraphobia and Generalized Anxiety Disorder

Vedrana Ikic,¹ Claude Bélanger,² Stéphane Bouchard,³ Patrick Gosselin,⁴ Frédéric Langlois,⁵ Joane Labrecque,⁶ Michel J. Dugas,⁷ André Marchand*⁸

¹Ph.D. (Cand.), Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada.
²Ph.D., Professor, Department of Psychology, Université du Québec à Montréal; Associate Professor, Department of Psychiatry, McGill University, Montréal, QC, Canada.
³Ph.D., Professor, Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada.
⁴Ph.D., Professor, Department of Psychology, Université de Sherbrooke, Sherbrooke, QC, Canada.
⁵Ph.D., Professor, Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.
⁶Ph.D., Psychologist, Anxiety Disorders Clinic, Hôpital du Sacré-C¾ur de Montréal, Montréal, QC, Canada.
⁷Ph.D., Professor, Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada.
⁸Ph.D., Professor, Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada.

Background: Panic disorder with agoraphobia (PDA) and generalized anxiety disorder (GAD) are impairing and costly disorders that are often misdiagnosed and left untreated despite multiple consultations. These disorders frequently co-occur, but little is known about the costs associated with their comorbidity and the impact of cognitive-behavioral therapy (CBT) on cost reduction.

Aims of the Study: The first objective of this study was to assess the mental health-related costs associated with the specific concomitance of PDA and GAD. The second aim was to determine whether there is a reduction in direct and indirect mental health-related costs following conventional CBT for the primary disorder only (PDA or GAD) or combined CBT adapted to the comorbidity (PDA and GAD).

Methods: A total of 123 participants with a double diagnosis of PDA and GAD participated in this study. Direct and indirect mental health-related costs were assessed and calculated from a societal perspective at the pre-test, the post-test, and the three-month, six-month and one-year follow-ups.

Results: At the pre-test, PDA-GAD comorbidity was found to generate a mean total cost of CAD$2,000.48 (SD = $2,069.62) per participant over a three-month period. The indirect costs were much higher than the direct costs. Both treatment modalities led to significant and similar decreases in all cost categories from the pre-test to the post-test. This reduction was maintained until the one-year follow-up.

Discussion: Methodological choices may have underestimated cost evaluations. Nonetheless, this study supports the cost offset effects of both conventional CBT for primary PDA or GAD and combined CBT for PDA-GAD comorbidity.

Implications for Healthcare Provision and Use: Treatment of comorbid and costly disorders with evidence-based treatments such as CBT may lead to considerable economic benefits for society.

Implications for Health Policies: Considering the limited resources of healthcare systems, it is important to make choices that will lead to better accessibility of quality services. The application of CBT for PDA, GAD or both disorders and training mental health professionals in this therapeutic approach should be encouraged. Additionally, it would be favorable for insurance plans to reimburse employees for expenses associated with psychological treatment for anxiety disorders.

Implications for Further Research: In addition to symptom reduction, it would be of great pertinence to explore which factors can contribute to reducing direct and indirect mental health-related costs.