Direkte Kosten sozialer Angststörung bei Jugendlichen und Kosteneffektivität der Psychotherapie

Zusammenfassung

Hintergrund Ziel war die Analyse direkter Kosten sozialer Angststörung (SAD) bei Jugendlichen und der Kosteneffektivität von CBT bzw. PDT.

Methoden Multizentrische randomisierte Studie mit N = 103 Patienten. Krankheitskosten wurden zur Baseline und Kosteneffektivität nach der Behandlung analysiert.

Ergebnisse Direkte 6-Monats-Kosten zu Baseline lagen bei 809 €. Während die inkrementelle Kosten-Effektivitäts-Relation von CBT im Vergleich zur Warteliste bei 18 824 €/QALY lag, war PDT nicht kosteneffektiv.

Zusammenfassung SAD verursacht hohe direkte Kosten. CBT ist wahrscheinlich kosteneffektiv.

Abstract

Objectives Social anxiety disorder is one of the most prevalent mental disorders and often manifests in youth or adolescence. Our aim was to determine direct costs of adolescents with social anxiety disorder and the cost-effectiveness of cognitive-behavioral therapy (CBT) and psychodynamic therapy (PDT) compared to waiting list (WL).

Methods Baseline data (n = 103) of a randomized controlled trial was used to determine direct costs. Cost-effectiveness of CBT and PDT compared to WL was analyzed using quality-adjusted life years (QALYs) based on the EQ-5D index as measure of health effects.

Results Total six-month direct costs were 809 € (SE 508 €). Especially costs of outpatient physician treatment (325 €; SE 301 €) and psychiatric hospital stays (377 €; SE 258 €) were high. The incremental cost-effectiveness ratio (ICER) of CBT compared to WL was 18,824 €/QALY, with a probability of 63 % for the ICER being below 50,000 €/QALY. PDT did not prove to be cost-effective.

Conclusions Direct costs were mainly caused by psychiatric hospital stays and outpatient physician treatments. CBT is likely to be cost-effective compared to WL, whereas PDT is unlikely to be cost-effective.

Schlüsselwörter

gesundheitsökonomische Evaluation - soziale Angststörungen bei Jugendlichen - Krankheitskosten - Kosteneffektivität

Keywords

health economic evaluation - social anxiety disorder for adolescents - cost-of-illness - cost-effectiveness

• Literatur

• 1 Stein MB, Stein DJ. Social anxiety disorder. Lancet 2008; 371: 1115-1125
• 2 Steinert C, Hofmann M, Leichsenring F. et al. What do we know today about the prospective long-term course of social anxiety disorder? A systematic literature review. J Anxiety Disord 2013; 27: 692-702
• 3 Sommer M, Hiller TS, Breitbart J. et al. Standardtherapie für Panikstörung mit/ohne Agoraphobie in der Hausarztpraxis. Psychiat Prax 2018; 45: 160-163
• 4 Russell G, Topham P. The impact of social anxiety on student learning and well-being in higher education. J Ment Health 2012; 21: 375-385
• 5 Fehm L, Pelissolo A, Furmark T. et al. Size and burden of social phobia in Europe. Eur Neuropsychopharmacol 2005; 15: 453-462
• 6 Lipsitz JD, Schneier FR. Social phobia. Epidemiology and cost of illness. Pharmacoeconomics 2000; 18: 23-32
• 7 Bech P, Angst J. Quality of life in anxiety and social phobia. Int Clin Psychopharmacol 1996; 11 (Suppl. 03) 97-100
• 8 Bandelow B, Lichte T, Rudolf SW. et al. S3-Leitlinie Angststörungen. Berlin, Heidelberg: Springer-Verlag; 2015
• 9 Konnopka A, Leichsenring F, Leibling E. et al. Cost-of-illness studies and cost-effectiveness analyses in anxiety disorders: a systematic review. J Affect Disord 2009; 114: 14-31
• 10 Stuhldreher N, Leibing E, Leichsenring F. et al. The costs of social anxiety disorder: the role of symptom severity and comorbidities. J Affect Disord 2014; 165: 87-94
• 11 Olesen J, Gustavsson A, Svensson M. et al. The economic cost of brain disorders in Europe. Eur J Neurol 2012; 19: 155-162
• 12 Egger N, Konnopka A, Beutel ME. et al. Short-term cost-effectiveness of psychodynamic therapy and cognitive-behavioral therapy in social anxiety disorder: Results from the SOPHO-NET trial. J Affect Disord 2015; 180: 21-28
• 13 Salzer S, Stefini A, Kronmüller K-T. et al. Cognitive-behavioral therapy and psychodynamic therapy in adoloscents with social anxiety disorder: a multicenter randomized controlled trial. Psychother Psychosom 2018; 12: 1-11
• 14 Delmo C, Weiffenbach O, Gabriel M. et al. 3. Auflage der deutschen Forschungsversion des K-SADS-PL, erweitert um ICD-10-Diagnostik. Bern: Huber; 2000
• 15 Clark D, Wells A. A cognitive model of social phobia. New York: Guilford; 1995
• 16 Luborsky L. Principles of Psychoanalytic Psychotherapy: Manual for Supportive-Expressive Treatment. New York: Basic Books; 1984
• 17 Leichsenring F, Beutel M, Leibing E. Psychodynamic psychotherapy for social phobia: a treatment manual based on supportive-expressive therapy. Bull Menninger Clin 2007; 71: 56-83
• 18 Wittchen HU, Zaudig M, Fydrich T. Strukturiertes Klinisches Interview für DSM-IV (SKID-I und SKID-II). Göttingen: Hogrefe; 1997
• 19 Mennin DS, Fresco DM, Heimberg RG. et al. Screening for social anxiety disorder in the clinical setting: using the Liebowitz Social Anxiety Scale. J Anxiety Disord 2002; 16: 661-673
• 20 Dolan P. Modeling valuations for EuroQol health states. Med Care 1997; 35: 1095-1108
• 21 Roick C, Kilian R, Matschinger H. et al. Die deutsche Version des Client Sociodemographic and Service Receipt Inventory – ein Instrument zur Erfassung psychiatrischer Versorgungskosten. Psychiat Prax 2001; 28 (Suppl. 02) S84-90
• 22 Bock J, Brettschneider C, Seidl H. et al. Ermittlung standardisierter Bewertungssätze aus gesellschaftlicher Perspektive für die gesundheitsökonomische Evaluation. Gesundheitswesen (Bundesverband der Ärzte des Öffentlichen Gesundheitsdienstes) 2015; 77: 53-61
• 23 Rote Liste Service GmbH. Rote Liste 2014. Arzneimittelverzeichnis für Deutschland. Frankfurt am Main: Rote Liste Service GmbH; 2014
• 24 van Buuren S, Groothuis-Oudshoorn K. mice: Multivariate Imputation by Chained Equations in R. J Stat Softw 2011; 45: 1-67
• 25 Gray AMM. Applied methods of cost-effectiveness analysis in health care. Handbooks in health economic evaluation. Oxford: Oxford Univ. Press; 2011
• 26 Isaranuwatchai W, Markle-Reid M, Hoch JS. Adjusting for Baseline Covariates in Net Benefit Regression: How You Adjust Matters. Pharmacoeconomics 2015; 33: 1083-1090
• 27 Grosse SD. Assessing cost-effectiveness in healthcare: history of the $50,000 per QALY threshold. Expert Rev Pharmacoecon Outcomes Res 2008; 8: 165-178
• 28 Acarturk C, Smit F, de Graaf R. et al. Economic costs of social phobia: a population-based study. J Affect Disord 2009; 115: 421-429
• 29 Patel A, Knapp M, Henderson J. et al. The economic consequences of social phobia. J Affect Disord 2002; 68: 221-233
• 30 Rees CS, Richards JC, Smith LM. Medical utilisation and costs in panic disorder: a comparison with social phobia. J Anxiety Disord 1998; 12: 421-435
• 31 Smit F, Cuijpers P, Oostenbrink J. et al. Costs of nine common mental disorders: implications for curative and preventive psychiatry. J Ment Health Policy Econ 2006; 9: 193-200
• 32 Leichsenring F, Rabung S. Effectiveness of long-term psychodynamic psychotherapy: a meta-analysis. JAMA 2008; 300: 1551-1565
• 33 Bandelow B, Reitt M, Rover C. et al. Efficacy of treatments for anxiety disorders: a meta-analysis. Int Clin Psychopharmacol 2015; 30: 183-192
• 34 Keefe JR, McCarthy KS, Dinger U. et al. A meta-analytic review of psychodynamic therapies for anxiety disorders. Clin Psychol Rev 2014; 34: 309-323
• 35 Veddegjaerde KE. Long-term effect of cognitive behavioral therapy in patients with health anxiety. European Psychiatry 2017; 41: S111-S112
• 36 Egger N, Konnopka A, Beutel ME. et al. Long-term cost-effectiveness of cognitive behavioral therapy versus psychodynamic therapy in social anxiety disorder. Depress Anxiety 2016; 33: 1114-1122
• 37 Brettschneider C, Djadran H, Harter M. et al. Cost-utility analyses of cognitive-behavioural therapy of depression: a systematic review. Psychother Psychosom 2015; 84: 6-21
• 38 Burnand Y, Andreoli A, Kolatte E. et al. Psychodynamic psychotherapy and clomipramine in the treatment of major depression. Psychiatr Serv 2002; 53: 585-590
• 39 Chernyak N, Sattel H, Scheer M. et al. Economic evaluation of brief psychodynamic interpersonal therapy in patients with multisomatoform disorder. PLoS One 2014; 9: e83894
• 40 Ingul JM, Aune T, Nordahl HM. A randomized controlled trial of individual cognitive therapy, group cognitive behaviour therapy and attentional placebo for adolescent social phobia. Psychother Psychosom 2014; 83: 54-61
• 41 Spence SH, Donovan CL, March S. et al. Generic versus disorder specific cognitive behavior therapy for social anxiety disorder in youth: A randomized controlled trial using internet delivery. Behav Res Ther 2017; 90: 41-57
• 42 Sportel BE, de Hullu E, de Jong PJ. et al. Cognitive bias modification versus CBT in reducing adolescent social anxiety: a randomized controlled trial. PLoS One 2013; 8: e64355