Coordinated Anxiety Treatment: Worth the Cost
McNamara, Damian, Clinical Psychiatry News
BOCA RATON, FLA. -- The incremental clinical benefit afforded by a flexible treatment delivery program for anxiety disorders in primary care settings costs more than usual care does, but is worth the extra expenditure, according to a study.
Patients who were randomized to the CALM (Coordinated Anxiety Learning and Management) program chose cognitive-behavioral therapy or medication. A care manager, primary care physician, and psychiatrist or psychologist managed their anxiety in this collaborative care model.
The incremental net benefit of CALM was positive if each anxiety-free day is valued at $30 or higher, Jutta M. Joesch, Ph.D., said during a late-breaking research session at the meeting, which was sponsored by the National Institute of Mental Health.
Other researchers recently demonstrated that CALM improves anxiety symptoms, functional disability, and quality of anxiety care, compared with usual care (JAMA 2010;303:1921-8) Participants were aged 18-75 years, and had panic, generalized anxiety, social anxiety, and/or posttraumatic stress disorder with or without major depression. They were randomized to CALM or usual care in 17 primary care clinics in four U.S. cities in 2006-2009. Treatment lasted up to 12 months, and patients were blindly assessed at 6, 12, and 18 months from baseline.
Dr. Joesch performed a secondary analysis of this trial to determine whether the incremental net benefit of CALM--compared with usual care - was worthwhile, given the incremental clinical benefit and incremental health care use costs.
Over 18 months, for example, the 372 CALM patients had an average of 56 additional anxiety-free days, compared with the 360 patients in the usual care group, Dr. Joesch said. Days with and without anxiety were estimated using scores on the 12-item Brief Symptom Inventory. …