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Cost Effectiveness of Acute Imipramine Therapy versus Two Imipramine Maintenance Treatment Regimens for Panic Disorder

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Abstract

Objective: To examine the medical costs and effectiveness of acute treatment with imipramine versus acute treatment plus 2 different maintenance therapies for panic disorder.

Methods: A clinical decision model was constructed to estimate 18-month costs and outcomes associated with these treatment scenarios based on the medical literature and clinician judgment. The clinical parameters and outcomes for the model were derived from a series of systematic clinical trials with imipramine utilising uniform dosage procedures and validated response criteria. Costs were calculated based on standardised treatment regimens. The outcome measures were 18-month medical costs, quality-adjusted life years (QALYs) and costs per QALY gained. A sensitivity analysis was performed to explore the impact of treatment withdrawals on outcomes.

Study perspective: US mental healthcare system.

Results: Over 18 months, the total costs (1997 values) and QALYs associated with half-dose maintenance therapy (imipramine 1.1 mg/kg/day) [$US3377; QALYs = 0.991] and full-dose maintenance therapy (imipramine 2.25 mg/kg/ day) [$US3361; QALYs = 0.991] were almost identical; both were cost saving compared with acute imipramine therapy (2.25 mg/kg/day) with no maintenance treatment ($US3691; QALYs = 0.979).Whether patients with drawing from treatment were considered to have continued to respond to treatment or to have relapsed, the half-dose and full-dose maintenance treatments were still cost saving compared with acute treatment alone.

Conclusions: The results indicate that imipramine maintenance treatment is cost effective compared with acute imipramine treatment for patients with panic disorder. The basic findings and conclusions are not affected after modifying model assumptions for clinical response in patients withdrawing from treatment.

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Acknowledgements

Supported in part by Grant MH42730 from the National Institute of Mental Health, Bethesda, MD, USA.

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Authors and Affiliations

  1. Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio, USA

    Matig R. Mavissakalian

  2. Center for Health Outcomes Research, MEDTAP International, Bethesda, Maryland, USA

    Jordana K. Schmier, Jennifer A. Flynn & Dennis A. Revicki

  3. Louis Stokes VAMC, Anxiety Disorders Program, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, Ohio, 44106, USA

    Matig R. Mavissakalian

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  1. Matig R. Mavissakalian
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  3. Jennifer A. Flynn
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Mavissakalian, M.R., Schmier, J.K., Flynn, J.A. et al. Cost Effectiveness of Acute Imipramine Therapy versus Two Imipramine Maintenance Treatment Regimens for Panic Disorder. Pharmacoeconomics 18, 383–391 (2000). https://doi.org/10.2165/00019053-200018040-00006

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