Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
Centre of Economic Evaluation, Trimbos Institute (Netherlands Institute for Mental Health and Addiction), Utrecht, The Netherlands.
PLoS One. 2018 Nov 7;13(11):e0205876. doi: 10.1371/journal.pone.0205876. eCollection 2018.
Panic disorder is associated with high productivity costs. These costs, which should be included in cost-effectiveness analyses (CEA) from a societal perspective, have a considerable impact on cost-effectiveness estimates. However, they are often omitted in published CEAs. It is therefore uncertain whether choosing a societal perspective changes priority setting in future research as compared to a healthcare perspective.
To identify research priorities regarding the cost-effectiveness of an early intervention for subthreshold panic disorder using value of information (VOI) analysis and to investigate to what extent priority setting depends on the perspective.
We calculated the cost-effectiveness of an early intervention for panic disorder from a healthcare perspective and a societal perspective. We performed a VOI analysis, which estimates the expected value of eliminating the uncertainty surrounding cost-effectiveness estimates, for both perspectives.
From a healthcare perspective the early intervention was more effective at higher costs compared to usual care (€17,144 per QALY), whereas it was cost-saving from a societal perspective. Additional research to eliminate parameter uncertainty was valued at €129.7 million from a healthcare perspective and €29.5 million from a societal perspective. Additional research on the early intervention utility gain was most valuable from a healthcare perspective, whereas from a societal perspective additional research would generate little added value.
Priority setting for future research differed substantially according to the perspective. Our study underlines that the health-economic perspective of CEAs on interventions for panic disorder must be chosen carefully in order to avoid inappropriate choices in research priorities.
恐慌症与高生产力成本相关。这些成本应从社会角度纳入成本效益分析（CEA），它们对成本效益估计有重大影响。然而，在已发表的 CEA 中，这些成本往往被忽略。因此，与医疗保健角度相比，选择社会角度是否会改变未来研究的优先顺序尚不确定。
使用信息价值（VOI）分析确定亚临床恐慌症早期干预的成本效益的研究重点，并研究优先顺序在多大程度上取决于视角。
我们从医疗保健角度和社会角度计算了恐慌症早期干预的成本效益。我们对这两种观点都进行了 VOI 分析，该分析估计了消除成本效益估计不确定性的预期价值。
从医疗保健角度来看，早期干预比常规护理（每 QALY 花费 17,144 欧元）更有效，但从社会角度来看，它是节省成本的。为消除参数不确定性而进行的额外研究，从医疗保健角度来看价值为 1.297 亿欧元，从社会角度来看价值为 2950 万欧元。从医疗保健角度来看，关于早期干预效用增益的额外研究最有价值，而从社会角度来看，额外研究产生的附加值很小。
根据视角的不同，未来研究的优先顺序有很大差异。我们的研究强调，为恐慌症干预措施进行 CEA 的健康经济学视角必须谨慎选择，以避免在研究优先顺序方面做出不适当的选择。
