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Preventing panic disorder: cost-effectiveness analysis alongside a pragmatic randomised trial

Filip Smit12*, Godelief Willemse1, Peter Meulenbeek3, Marc Koopmanschap4, Anton van Balkom5, Philip Spinhoven6 and Pim Cuijpers7

Author Affiliations

1 Centre of Prevention and Early Intervention, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, the Netherlands

2 Institute of Extra-Mural Medicine, VU University Medical Centre, Amsterdam, the Netherlands

3 Department of Research and Brief Intervention, GGNet (community mental health centre), Warnsveld, the Netherlands

4 Institute of Medical Technology Assessment, Erasmus University Medical Centre, Rotterdam, the Netherlands

5 Department of Psychiatry and EMGO Institute, VU University Medical Centre, Amsterdam, the Netherlands

6 Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands

7 Department of Clinical Psychology and EMGO Institute, VU University Medical Centre, Amsterdam, the Netherlands

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Cost Effectiveness and Resource Allocation 2009, 7:8  doi:10.1186/1478-7547-7-8

Published: 24 April 2009



Panic disorder affects many people, is associated with a formidable disease burden, and imposes costs on society. The annual influx of new cases of panic disorder is substantial. From the public health perspective it may therefore be a sound policy to reduce the influx of new cases, to maintain the quality of life in many people, and to avoid the economic costs associated with the full-blown disorder. For this purpose, prevention is needed. Here we present the first economic evaluation of such an intervention.


Randomised trial of 117 people with panic disorder symptoms not meeting the diagnostic criteria of DSM-IV panic disorder. The interventions were time-limited cognitive-behavioural therapy v care-as-usual. The central clinical endpoint was DSM-IV panic disorder-free survival over 3 months. Costs were calculated from the societal perspective. Using the bootstrap method, incremental cost-effectiveness ratios were obtained, placed in 95% confidence intervals, projected on the cost-effectiveness plane, and presented as acceptability curves.


The median incremental cost-effectiveness ratio is €6,198 (95% CI 2,435 – 60,731) per PD-free survival gained, which has a likelihood of 75.2% of being more acceptable from a cost-effectiveness point of view than care-as-usual when a willingness-to-pay ceiling is assumed of €10,000 per PD-free survival. The most significant cost driver was therapists' time. A sensitivity analysis indicated that cost-effectiveness improves when the number of therapist hours is reduced.


This is the first economic evaluation alongside a prevention trial in panic disorder. The small sample (n = 117) and the short time horizon of 3 months preclude firm conclusions, but our findings suggest that the intervention may be acceptable from a cost-effectiveness point of view, especially when therapist involvement can be kept minimal. Nevertheless, our results must await replication in a larger trial with longer follow-up times before we can confidently recommend implementation of the intervention on a broad scale. In the light of our findings and given the burden of panic disorder, such a new trial is well worth the effort.

Trial registration

Current Controlled Trials ISRCTN33407455.