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School of Health and Related Research (ScHARR), University of Sheffield. Clinical Guidelines for the Management of Anxiety: Management of Anxiety (Panic Disorder, with or without Agoraphobia, and Generalised Anxiety Disorder) in Adults in Primary, Secondary and Community Care [Internet]. London: National Collaborating Centre for Primary Care (UK); 2004 Dec. (NICE Clinical Guidelines, No. 22.)

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

Cover of Clinical Guidelines for the Management of Anxiety

Clinical Guidelines for the Management of Anxiety: Management of Anxiety (Panic Disorder, with or without Agoraphobia, and Generalised Anxiety Disorder) in Adults in Primary, Secondary and Community Care [Internet].

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Appendix 22Costs of CBT and self help treatments

The evidence relating to the costs of the provision of CBT and self help treatments from a UK perspective is limited. Costs quoted are highly variable ranging from £164 - £700 per course of therapy for CBT. A recent systematic review of the clinical and cost effectiveness of self help treatments for anxiety and depressive disorders in primary care found that none of the identified studies had reported data on costs (Bower et al, 2000).There is some evidence to suggest that CBT therapy may be a cost effective option for patients with panic disorder in comparison with pharmacotherapy over the longer term (Bower et al, 2003). However, total costs of CBT therapy are likely to vary according to number of sessions provided, setting of CBT, personnel providing the service and volume of patients. Further research is required to determine the total costs of CBT for patients with anxiety/panic disorder in a UK setting.

Otto et al 2000

Treatment of panic disorder with CBT commonly requires patients to come to the clinic for 12–15 sessions, attend fear provoking situations and events during sessions and complete home practice of skills and procedures reviewed during session. Visit costs of individual and group CBT were $114 and $48 respectively for a standard 50 minute session. Total reported costs of group CBT at 4 and 12 months were $518 and $523, for individual CBT were $1,186 and $1,457 and for Psychopharmacology were $839 and $2,305 respectively. The outcome analysis indicated that regardless of previous medication status, treatment with CBT provided patients with short term benefits that were at least equal and possibly superior to those afforded by short term pharmacotherapy alone.

Bower et al 2000

This study compares the cost effectiveness of non-directive counselling, cognitive-behaviour therapy and routine general practitioner care in the management of depression and mixed anxiety and depression from a UK perspective. The study was designed as a cost effectiveness study with the Beck depression inventory as the main outcome and the EQ-5D as a secondary outcome measure. A societal perspective was taken for the measurement of costs. The main study sample consisted of 197 patients randomly allocated to one of the three treatments. Patients allocated to psychological therapy received 6–12 sessions with a qualified therapist. Patients in usual care were managed by their general practitioner.

The tables below are reproduced from this paper and shows the resources used and costs associated with the provision of CBT.

Table 1Resources used 12 months after entry to trial by patients given CBT for depression. Values are mean (SD) number of contacts

ServiceCBT (n=63)
GP surgery contacts6.48 (4.6)
Non-attendances0.26 (0.55)
Out of hours contacts0.03 (0.13)
GP cooperative0.07 (0.25)
GP home visits0.03 (0.18)
Practice nurse contacts0.69 (0.95)
Non-attendances0.03 (0.18)
Sessions attended for protocol therapy4.97 (3.5)
Non attendances1.36 (1.5)
Mental health referrals0.22 (0.52)
Non-psychiatric referrals0.92 (1.26)

Table 2Total costs (£) of CBT for depression at 12 month follow up. Values are mean (SD) costs

ServiceCBT (n=63)
Primary care86.8 (59.8)
Drugs12.2 (37.5)
Out-patients105.9 (251.9)
In-patients74.2 (381.8)
Protocol therapy164.3 (104.1)
Travel costs5.5 (8.8)

Kaltenthaler et al 2002

Two different methods for costing CBT are reported. The first method uses the annual salary of a therapist (including on costs) and assumes that the therapist will deal with 50 new patients per year. The cost per completed treatment episode is estimated to be the salary divided by 50 (£700). However this estimate assumes that all of the therapist’s time is taken up treating the 50 patients which is unlikely to be the case. The second method uses an annual rate for a therapist’s time. This rate is multiplied by the mean number of sessions a therapist would need to yield a 50% improvement in a patient. This is estimated to be £606 per patient.

Additional NHS costs per patients from CCBT were estimated to be between £26 and £40 (depending upon volume of referrals and proportion of computer costs attributed).

Fear fighter (ST solutions)

A mean cost per patient of £549 for CBT is quoted. However this is based upon a mean time spent with a therapist of 9 hours per patient (taken from the British Association of Behavioural and Cognitive Therapy). The RCT evidence from the submission suggests that patients spent much less time than this on average with a therapist (4 hours 43 minutes) giving a mean cost per patient of £288.

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Management of panic disorder in primary care: Steps 2–4 (PDF, 30K)

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Management of generalised anxiety disorder in primary care: Steps 2–4 (PDF, 32K)

Copyright © 2004, National Collaborating Centre for Primary Care.
Bookshelf ID: NBK45832

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