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. 2015 Oct 27;10(10):e0140704.
doi: 10.1371/journal.pone.0140704. eCollection 2015.

The Cost Effectiveness of Psychological and Pharmacological Interventions for Social Anxiety Disorder: A Model-Based Economic Analysis

Ifigeneia Mavranezouli  1 , Evan Mayo-Wilson  1 , Sofia Dias  2 , Kayleigh Kew  1 , David M Clark  3 , A E Ades  2 , Stephen Pilling  1
Affiliations

The Cost Effectiveness of Psychological and Pharmacological Interventions for Social Anxiety Disorder: A Model-Based Economic Analysis

Ifigeneia Mavranezouli et al. PLoS One. .

Abstract

Background: Social anxiety disorder is one of the most persistent and common anxiety disorders. Individually delivered psychological therapies are the most effective treatment options for adults with social anxiety disorder, but they are associated with high intervention costs. Therefore, the objective of this study was to assess the relative cost effectiveness of a variety of psychological and pharmacological interventions for adults with social anxiety disorder.

Methods: A decision-analytic model was constructed to compare costs and quality adjusted life years (QALYs) of 28 interventions for social anxiety disorder from the perspective of the British National Health Service and personal social services. Efficacy data were derived from a systematic review and network meta-analysis. Other model input parameters were based on published literature and national sources, supplemented by expert opinion.

Results: Individual cognitive therapy was the most cost-effective intervention for adults with social anxiety disorder, followed by generic individual cognitive behavioural therapy (CBT), phenelzine and book-based self-help without support. Other drugs, group-based psychological interventions and other individually delivered psychological interventions were less cost-effective. Results were influenced by limited evidence suggesting superiority of psychological interventions over drugs in retaining long-term effects. The analysis did not take into account side effects of drugs.

Conclusion: Various forms of individually delivered CBT appear to be the most cost-effective options for the treatment of adults with social anxiety disorder. Consideration of side effects of drugs would only strengthen this conclusion, as it would improve even further the cost effectiveness of individually delivered CBT relative to phenelzine, which was the next most cost-effective option, due to the serious side effects associated with phenelzine. Further research needs to determine more accurately the long-term comparative benefits and harms of psychological and pharmacological interventions for social anxiety disorder and establish their relative cost effectiveness with greater certainty.

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Conflict of interest statement

Competing Interests: The authors have read the journal's policy and the authors of this manuscript have the following competing interests: IM, EMW, KK and SP received support from the National Collaborating Centre for Mental Health, which was in receipt of funding from the National Institute for Health and Care Excellence (NICE), for the submitted work. SD and AEA received support from the NICE Clinical Guidelines Technical Support Unit, University of Bristol, with funding from the Centre for Clinical Practice (NICE). DMC is the developer of one of the versions of individual CBT under consideration (Cognitive Therapy following the Clark & Wells manual). The authors report no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig 1
Fig 1. Schematic diagram of the economic model constructed to assess the cost-effectiveness of interventions for social anxiety disorder.
Fig 2
Fig 2. Cost-effectiveness plane showing the incremental costs and QALYs of all interventions versus wait list.
Wait list is placed at the origin; results are for 1,000 adults with social anxiety disorder at 5 years after treatment. The continuous line shows the cost-effectiveness efficiency frontier, while the slope of the dotted line indicates the NICE lower cost effectiveness threshold (£20,000/QALY). The data used to construct Fig 2 are provided in Table 5.
Fig 3
Fig 3. Cost-effectiveness acceptability frontier of pharmacological and psychological interventions for adults with social anxiety disorder.
The values used to construct Fig 3 are provided in S2 Table.
See this image and copyright information in PMC

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