1 CCBT for Panic Disorder

Transcription

1 for Panic Disorder. vs Wait-list control for Panic disorder Measure of of Life (psychological) (Better indicated by lower values) patients Wait-list control Non Panic free status (clinician and self-report) - Non-Remission ( mth posttreatment no longer fulfill PD diagnostic criteria) very serious serious 49/5 /5 (96.%) (4.%) 00% High heterogeneity (>80%) serious 5/5 (9.8%) 3/50 (6%) 5.8% RR 0.44 (0. to.55) RR.48 (0. to 0.79) SMD.9 lower (.7 to 0.86 lower) SMD 0.84 lower (.39 to 0.9 lower) SMD 0.55 lower (0.95 to 0.5 lower) 538 fewer per 000 (from 845 fewer to 58 more) 560 fewer per 000 (from 880 fewer to 550 more) 9 more per 000 (from 48 fewer to 587 more) 8 more per 000 (from 46 fewer to 568 more) ΟΟΟ VERY Internet Psychiatri versus waiting list Study & Limitatio ns Applicability comments Incremen tal cost effect ICER ( /effect) Uncertainty Appendix 9d

2 (model 3) limitation s ( ) Time horizon: year ,6/QALY Probability of Internet Psychiatri being cost-effective at 0,000/QALY: 85.3%. Costs expressed in 009 pounds. Limited evidence base ( RCTs); intervention currently not available in the 3. Analysis conducted to assist guideline development; NHS & personal social services perspective; QALYs estimated based on EQ-5D. vs information control for Panic disorder Measure of panic severity (Better indicated by lower values) serious serious Measure of of life (Psychological) (Better indicated by lower values) randomised serious Non "Panic free" status (clinician and self-report) - Non panic free serious patients information control /3 (9%) 3/3 (9.7%) 5/7 (9.6%) 9.7% 7/7 (5.9%) RR 0.3 (0.8 to 0.56) RR 0.4 (0. to.63) SMD 0. lower (0.77 lower to 0.58 higher) SMD.9 lower (3.04 to 0.76 lower) SMD 0.57 lower (. to 0.04 lower) SMD 0.5 lower (. lower to 0.6 higher) 630 fewer per 000 (from 407 fewer to 759 fewer) 64 fewer per 000 (from 403 fewer to 75 fewer) 50 fewer per 000 (from 3 fewer to 63 more) Appendix 9d

3 Moderate heterogeneity (50-80%) 5% 45 fewer per 000 (from fewer to 57 more) Panic online versus information control Study & Klein et al., 006 Australia (model ) Limitations Applicability comments Incremen tal cost ( ) Potentially serious 4 Partially applicable 5 Time horizon: 6 weeks Cost-consequence effect 4 See GRADE clinical profile above ICER ( /effect) Non- Applicable Time horizon: year ,599/QAL Y Uncertainty No statistical of costs Probability of cost effectiveness at 0,000/QALY: 9%. Costs converted and uplifted to 009 pounds, using PPP exchange rates ( and the HCHS inflation index; assuming study cost year Short time horizon; intervention costs only considered; various panic, anxiety and cognition outcomes measured (cost-consequence ) 3. Australian study; narrow perspective (intervention costs only considered); local prices used; no QALYs estimated but outcome measures considered relevant in guideline systematic review of clinical evidence 4. Limited evidence base ( RCTs); intervention currently not available in the 5. Analysis conducted to assist guideline development; NHS & personal social services perspective; QALYs estimated based on EQ-5D.3 vs any control (WLC or information control) for Panic disorder serious serious Measure of panic severity (Better indicated by lower values) serious patients any control (WLC or information control) SMD 0.7 lower (.4 lower to 0.0 higher) SMD.78 lower (.6 to.3 lower) Appendix 9d 3

4 serious Measure of of Life - QOL (Psychological) (Better indicated by lower values) 3 randomised Non-Panic free status (clinician and self-report) moderate heterogeneity (50-80%) different comparator 3 serious serious serious serious /8 (36.6%) 8/8 (9.8%) 74/78 (94.9%) 94.6% 0/77 (3%) 4.4% RR 0.38 (0.9 to SMD 0.7 lower (.05 to 0.4 lower) SMD 0.5 lower (0.86 to 0.4 lower) 588 fewer per 000 (from 09 fewer to 768 fewer) 0.78) 587 fewer per 000 (from 08 fewer to 766 fewer) 36 fewer per 000 (from 0 fewer to RR more) (0. to.4) 40 fewer per 000 (from fewer to 0 more).4 vs Face to Face CBT for Panic disorder serious serious serious Measure of of Life - QOL (Psychological) (Better indicated by lower values) serious Panic free status (clinician and self-report) patients Face to Face CBT SMD 0. higher (0.4 lower to 0.6 higher) SMD 0.3 higher (0. lower to 0.47 higher) SMD 0.09 higher (0.6 lower to 0.44 higher) Appendix 9d 4

5 Moderate heterogeneity (50-80%) serious serious 35/7 (49.3%) 8/7 (.3%) 33/64 (5.6%) 47.9% RR 0.95 (0.6 to.46) 6 fewer per 000 (from 0 fewer to 37 more) 4 fewer per 000 (from 87 fewer to 0 more) 3 more per 000 (from 5/64 (7.8%) RR.4 ( fewer to 50 more) to 4.) 36 more per 000 (from % fewer to 8 more) Deleted: Fear Fighter (FF) versus face-to-face CBT... [] Formatted Table Formatted Table Deleted: Kartenhaler et al., [] Deleted: 7 Deleted: 6 Deleted: 7 Study & Appendix 9d Limitation s Applicabilit y Panic Online (PO) versus face-to-face CBT (model ) Internet Psychiatri versus face-to-face CBT (model 4) comments cost ( ) Increment al effect ICER ( /effect) Uncertainty Time horizon: year ,849/QALY Probability of PO being cost-effective at 0,000/QALY: 7% Time horizon: year ccbt dominant Probability of Internet Psychiatri being cost-effective at 0,000/QALY: 95%. Costs uplifted to 009 pounds using the HCHS inflation index.. Limited evidence base ( RCT); intervention currently not available in the 3. Analysis conducted to assist guideline development; NHS & personal social services perspective; QALYs estimated based on EQ-5D.5 versus bibliotherapy 5 Deleted: 6 Deleted: <#>QALYs estimated from data on the self-reported global phobia item; panic symptoms not necessarily captured; short time horizon; resource use estimates based on manufacturers and assumptions <#>Study population not entirely relevant (people with panic phobia); HRQoL scores taken from European community-based mental health survey; overall state of panic disorder valued <#>Short time horizon; intervention costs only considered; outcomes measured as improvements in main symptoms & global phobia ratings; potential conflict of interest <#>Study population not entirely relevant (people with panic or phobic disorder); narrow perspective; no QALYs estimated but outcome measures considered relevant... [3]

6 Panic Online versus therapist-assisted self-administered CBT Study & Limitation s Applicability comments Increment al cost ( ) effect ICER ( /effect) Uncertainty Klein et al., 006 Austral ia Potentially serious Partially Time horizon: 6 weeks Cost-consequence - 4 See GRADE clinical profile above Non- Applicable No significant difference in costs. Costs converted and uplifted to 009 pounds, using PPP exchange rates ( and the HCHS inflation index; assuming study cost year Short time horizon; intervention costs only considered; various panic, anxiety and cognition outcomes measured (cost-consequence ) 3. Australian study; narrow perspective (intervention costs only considered); local prices used; no QALYs estimated but outcome measures considered relevant in guideline systematic review of clinical evidence Appendix 9d 6

7 Page 5: [] Deleted ifigeneia 6/09/00 0::00 Fear Fighter (FF) versus face-to-face CBT Page 5: [] Deleted ifigeneia 6/09/00 0::00 Partially Time horizon: months 0.0QALY s Kartenhale r et al., 006 McCrone et al., 009 Potentially serious 4 Partially applicable 5 Time horizon: 4 weeks Two analyses using: a. main problem ratings b. global phobia ratings a to - 34 b.- 33 to - 34 a b Page 5: [3] Deleted ifigeneia 6/09/00 0::00 QALYs estimated from data on the self-reported global phobia item; panic symptoms not necessarily captured; short time horizon; resource use estimates based on manufacturers and assumptions Study population not entirely relevant (people with panic phobia); HRQoL scores taken from European community-based mental health survey; overall state of panic disorder valued Short time horizon; intervention costs only considered; outcomes measured as improvements in main symptoms & global phobia ratings; potential conflict of interest Study population not entirely relevant (people with panic or phobic disorder); narrow perspective; no QALYs estimated but outcome measures considered relevant in guideline systematic review of clinical evidence,000/ QALY Probability o threshold of a. FF dominant b / mean improvement in global phobia rating