Cost-effectiveness analysis of an occupational therapy-led lifestyle approach and routine general practitioner’s care for panic disorder

Objective To assess the cost-effectiveness of an occupational therapy-led lifestyle approach to treating panic disorder in primary care compared with routine general practitioner’s (GP) care. The burden of mental health disorders is considerable. Cost-effective interventions are necessary to alleviate some of these burdens. Habitual lifestyle behaviours influence mood, although to date mainly single lifestyle factor trials have been conducted to examine the effects on anxiety. Methods An economic evaluation was conducted alongside an unblinded pragmatic randomised controlled trial with assessment at 5 and 10 months. Costs and consequences, as measured by the Beck anxiety inventory (BAI) and quality adjusted life years (QALYs), were compared using incremental cost-effectiveness ratios (ICERs). Results The occupational therapy-led lifestyle intervention was more costly than routine GP care at both 5 and 10 months. Significant outcome improvements were evident at 5 months when using the BAI, although these were not maintained at 10 months. Small differences in mean QALYs were found. The estimated ICER was £36 per BAI improvement for 5 months and £39 for 10 months, and £18,905 per QALY gained for 5 months and £8,283 for 10 months. Conclusions If the maximum willingness to pay per additional QALY is £30,000, then there is an 86% chance that a lifestyle intervention may be considered to be valuefor- money over 10 months.