Economic and humanistic burden of illness in generalized anxiety disorder: an analysis of patient survey data in Europe

Abstract

Background: Whilst studies suggest that generalized anxiety disorder (GAD) represents a considerable health care burden in Europe, there is a paucity of published evidence. This study investigated the burden of illness associated with GAD across five European countries (France, Germany, Italy, Spain, and the UK).

Methods: Information from the 2008 European National Health and Wellness Survey database was analyzed. Bivariate, multivariate, and cost analyses were used to compare patients with GAD and propensity-matched controls.

Results: Compared with non-GAD controls, patients with GAD had more comorbidities and were more likely to smoke but less likely to be employed, use alcohol, or take exercise. They also had significantly worse health-related quality of life, and significantly greater work impairment and resource use, which increased as GAD severity increased. Within-country analyses demonstrated results similar to those for the five European countries overall, with the largest differences in resource use between patients with GAD and non-GAD controls documented in France and Germany. The average mean differences in direct costs were relatively small between the GAD groups and controls; however, indirect costs differed substantially. Costs were particularly high in Germany, mainly due to higher salaries leading to higher costs associated with absence from work. The limitation of this study was that the data were from a self-reported Internet survey, making them subject to reporting bias and possibly sample bias.

Conclusion: Across all five European countries, GAD had a significant impact on work impairment, resource use, and economic costs, representing a considerable individual and financial burden that increased with severity of disease. These data may help us to understand better the burden and costs associated with GAD.

Keywords: Europe; burden of illness; economic burden; generalized anxiety disorder.

Figure 1

Impairment in work productivity and daily activities in patients with GAD. Notes: *P<0.05; **P<0.01; ***P<0.001 GAD patients versus non-GAD controls. Rate ratio >1 indicates the mean value for GAD patients is higher than for non-GAD controls. Europe overall refers to the five European countries included in this study. Data from across five European countries (France, Germany, Italy, Spain, and the UK) and within each country. Abbreviation: GAD, generalized anxiety disorder.

Figure 2

Difference in health care resource utilization in patients with GAD and non-GAD controls. Notes: Data shown are for (A) likelihood of visiting traditional and nontraditional health care providers and (B) type of health care interaction. *P<0.05; **P<0.01; ***P<0.001 GAD patients versus non-GAD controls. Rate ratio >1 indicates the mean value for GAD patients is higher than for non-GAD controls; rate ratio >1 indicates the mean value for GAD patients is lower than for non-GAD controls. Europe overall refers to the five European countries included in this study. Abbreviations: ER, emergency room; GAD, generalized anxiety disorder; HCP, health care provider.

Figure 3

Average direct and indirect costs per patient with GAD per year. Notes: Data from across France, Germany, Italy, Spain, and the UK (mean difference between patients with GAD and non-GAD controls) showing (A) direct costs and (B) indirect costs. ***P<0.001 GAD patients versus non-GAD controls. Abbreviation: GAD, generalized anxiety disorder.

Figure 4

Health care costs of GAD by GAD severity. Notes: Data show (A) average total costs per patient with GAD per year by GAD severity across five European countries (France, Germany, Italy, Spain, and the UK) and (B) mean difference in total costs for patients with GAD versus non-GAD controls by GAD severity within the five European countries. *P<0.05; **P<0.01; ***P<0.001 GAD patients versus non-GAD controls. Abbreviation: GAD, generalized anxiety disorder.