Estimation of symptom-free days in generalized anxiety disorder

Wan, George J.; Zhang, Huabin F.; Tedeschi, Michael; Hackett, D.

doi:10.1185/030079906x96245

Cited by 9 publications

(9 citation statements)

References 23 publications

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“…By contrast, in clinical studies, response and remission treatment outcomes correlate highly; by definition, patients achieving remission will also have achieved a response. 22 36 39 The possible reasons for the lack of correlation in our analysis are that our approach compared response and remission rates across a broad range of clinical studies, in varying settings, and was conducted in groups of patients with differing severity of symptoms and undergoing treatment with varying regimens. As a result, the data informing our meta-analysis did not represent a discrete or continuous population and some studies included in our analysis reported response rates only, with no remission data.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of drug treatments for generalised anxiety disorder: systematic review and meta-analysis

Baldwin

Woods²,

Lawson³

et al. 2011

BMJ

262

145

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Objective To appraise the evidence for comparative efficacy and tolerability of drug treatments in patients with generalised anxiety disorder. Design Systematic review of randomised controlled trials. Primary Bayesian probabilistic mixed treatment metaanalyses allowed pharmacological treatments to be ranked for effectiveness for each outcome measure, given as percentage probability of being the most effective treatment. Secondary frequentist mixed treatment metaanalyses conducted with random effects model; effect size reported as odds ratio and 95% confidence interval. Data sources Medline, Embase, BIOSIS, PsycINFO, Health Economic Evaluations Database, National Health Service Economic Evaluation Database, and Database of Abstracts of Reviews of Effects via DataStar, and Cochrane Database of Systematic Reviews via Cochrane Library (January 1980 to February 2009). Eligibility criteria Double blind placebo controlled randomised controlled trials; published systematic reviews and meta-analyses of randomised controlled trials. Randomised controlled trials including adult participants (aged ≥18) receiving any pharmacological treatment for generalised anxiety disorder. Data abstraction methods Titles or abstracts reviewed initially, followed by review of full text publications for citations remaining after first pass. A three person team conducted screening; an independent reviewer checked a random selection (10%) of articles screened. Data extracted for meta-analysis were also independently reviewed. Main outcome measures Proportion of participants experiencing ≥50% reduction from baseline score on Hamilton anxiety scale (HAM-A) (response), proportion with final HAM-A score ≤7 (remission), proportion withdrawing from trial because of adverse events (tolerability). Results The review identified 3249 citations, and 46 randomised controlled trials met inclusion criteria; 27 trials contained sufficient or appropriate data for inclusion in the analysis. Analyses compared nine drugs (duloxetine, escitalopram, fluoxetine, lorazepam, paroxetine, pregabalin, sertraline, tiagabine, and venlafaxine). In the primary probabilistic mixed treatment meta-analyses, fluoxetine was ranked first for response and remission (probability of 62.9% and 60.6%, respectively) and sertraline was ranked first for tolerability (49.3%). In a subanalysis ranking treatments for generalised anxiety disorder currently licensed in the United Kingdom, duloxetine was ranked first for response (third across all treatments; 2.7%), escitalopram was ranked first for remission (second across all treatments; 26.7%), and pregabalin was ranked first for tolerability (second across all treatments; 7.7%). Conclusions Though the frequentist analysis was inconclusive because of a high level of uncertainty in effect sizes (based on the relatively small number of comparative trials), the probabilistic analysis, which did not rely on significant outcomes, showed that fluoxetine (in terms of response and remission) and sertraline (in terms of tolerability) seem t...

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Section: Discussionmentioning

confidence: 99%

Efficacy of drug treatments for generalised anxiety disorder: systematic review and meta-analysis

Baldwin

Woods²,

Lawson³

et al. 2011

BMJ

262

145

View full text Add to dashboard Cite

show abstract

“…Second, measures of clinical effectiveness employed in our model include time (i.e., weeks) with no or minimal anxiety in addition to QALYs. While use of QALYs allows comparisons with findings from pharmacoeconomic evaluations of interventions for other medical conditions, use of “time without symptoms” may best reflect favorable clinical outcomes from the patient’s perspective [18–22]. We believe that our study is the first to report estimates of the cost-effectiveness of pharmacologic treatment of GAD using such a measure.…”

Section: Discussionmentioning

confidence: 99%

“…While (to the best of our knowledge) these categorizations have not been validated clinically, they have been employed by others [16, 17]. The value of using time without symptoms to compare treatments of chronic symptomatic diseases has long been recognized in a variety of medical conditions, including pain, depression, and epilepsy [18–22]. …”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of pregabalin versus venlafaxine in the treatment of generalized anxiety disorder: findings from a Spanish perspective

et al. 2009

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The objective of the present study was to describe a new model of the cost-effectiveness of treatment of generalized anxiety disorder (GAD) and its application to a comparison of pregabalin versus venlafaxine extended-release (XR) from a Spanish healthcare perspective. Microsimulation techniques, including Hamilton Anxiety Scale (HAM-A) score, number of weeks with minimal or no anxiety (HAM-A ≤ 9), and quality-adjusted life-years (QALYs), were used to predict treatment outcomes for patients with moderate-to-severe GAD who would be treated with pregabalin vs venlafaxine XR. Expected levels of healthcare utilization and unit cost of care are derived from Spanish published sources. We express cost-effectiveness alternatively in terms of incremental cost per additional week with minimal or no anxiety, and incremental cost per QALY gained [in 2007 Euros (€)]. Considering costs of drug treatment only, the incremental cost [mean (95% confidence interval)] of pregabalin (vs venlafaxine XR) would be €96 (€86, €107) per additional week with minimal or no anxiety, and €32,832 (€29,656, €36,308) per QALY gained. When other medical care costs are considered, cost-effectiveness ratios decline to €70 (€61, €80) per additional week with no or minimal anxiety, and €23,909 (€20,820, €27,006) per QALY gained. We conclude that, using a new microsimulation model of the treatment of GAD, pregabalin appears to be cost-effective vs venlafaxine XR in a Spanish healthcare setting.

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“…Following the characteristics of patients included in most clinical trials, the model considers that before implementation of any pharmacotherapeutic option all patients have either moderate or severe anxiety. Clinical gains are achieved whenever disease management allows subjects to be classified in less severe categories, following the rationale of valuing time without or with lighter symptoms that was already applied in economic evaluations of medical conditions as pain, depression and epilepsy [11-15]. …”

Section: Methodsmentioning

confidence: 99%

A cost-utility analysis of pregabalin versus venlafaxine XR in the treatment of generalized anxiety disorder in Portugal

Miguel

Miguel²,

Inês³

2013

Cost Eff Resour Alloc

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BackgroundGeneralized anxiety disorder is characterized by excessive anxiety and worry about several events and activities. The estimated 1-year prevalence for adults is around 2% and the lifetime prevalence could reach more than 6%. The disease is associated with reduced quality of life, being comparable to that of major depressive disorder and to chronic illnesses such as diabetes and arthritis, and high consumption of health care resources.MethodsA previously published patient-level simulation cost-utility model was adapted to the Portuguese context in order to evaluate clinical and economic consequences of using pregabalin in place of venlafaxine XR in the treatment of generalized anxiety disorder. The model predicts the evolution of 1,000 patients with generalized anxiety disorder, simulating their pathway in weekly cycles over one year treatment. This is done by setting a pre-treatment Hamilton Anxiety Scale score and projecting the weekly impact of the pharmacotherapy on this score. The model uses clinical data from an 8-week flexible dose direct comparison clinical trial between the two drugs; utility values based on a Spanish study; and Portuguese economic data, being the resource consumption obtained via an expert panel.ResultsPregabalin patients benefited from 0.738 quality adjusted life years while those on venlafaxine XR achieved 0.712. Moreover, the number of weeks with no or minimal anxiety symptoms was estimated to be 12.9 for pregabalin and only 3.8 for venlafaxine XR. Those clinical gains were achieved at the expense of an extra 715€ per patient, implying an incremental cost per quality adjusted life year of 27,199€ and an incremental cost per week with no or minimal symptoms of 79€. Sensitivity analysis shows that results are robust to main assumptions.ConclusionsAssuming a threshold of 30,000€ per quality adjusted life year, pregabalin is cost-effective in comparison with venlafaxine XR in the treatment of generalized anxiety disorder in Portugal.

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Estimation of symptom-free days in generalized anxiety disorder

Abstract: SFDs differentiate between active treatment and placebo in clinical trials and may be an appropriate measure of treatment effectiveness.

Cited by 9 publications

References 23 publications

Efficacy of drug treatments for generalised anxiety disorder: systematic review and meta-analysis

Efficacy of drug treatments for generalised anxiety disorder: systematic review and meta-analysis

Cost-effectiveness of pregabalin versus venlafaxine in the treatment of generalized anxiety disorder: findings from a Spanish perspective

A cost-utility analysis of pregabalin versus venlafaxine XR in the treatment of generalized anxiety disorder in Portugal

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