The cost-effectiveness of psychotherapy and paroxetine for severe irritable bowel syndrome.

Abstract

BACKGROUND & AIMS:

Psychotherapy and antidepressants are effective in patients with severe irritable bowel syndrome (IBS), but the cost-effectiveness of either treatment in routine practice has not been established.

METHODS:

Patients with severe IBS were randomly allocated to receive 8 sessions of individual psychotherapy, 20 mg daily of the specific serotonin reuptake inhibitor (SSRI) antidepressant, paroxetine, or routine care by a gastroenterologist and general practitioner. Primary outcome measures of abdominal pain, health-related quality of life, and health care costs were determined after 3 months of treatment and 1 year later.

RESULTS:

A total of 257 subjects (81% response rate) from 7 hospitals were recruited; 59 of 85 patients (69%) randomized to psychotherapy and 43 of 86 (50%) of the paroxetine group completed the full course of treatment. Both psychotherapy and paroxetine were superior to treatment as usual in improving the physical aspects of health-related quality of life (SF-36 physical component score improvement, 5.2 [SEM, 1.26], 5.8 [SEM, 1.0], and -0.3 [SEM, 1.17]; P < 0.001), but there was no difference in the psychological component. During the follow-up year, psychotherapy but not paroxetine was associated with a significant reduction in health care costs compared with treatment as usual (psychotherapy, $976 [SD, $984]; paroxetine, $1252 [SD, $1616]; and treatment as usual, $1663 [SD, $3177]).

CONCLUSIONS:

For patients with severe IBS, both psychotherapy and paroxetine improve health-related quality of life at no additional cost.

• Authors: Francis Creed, Lakshmi Fernandes, Elspeth Guthrie, Stephen Palmer, Joy Ratcliffe, Nicholas Read, Christine Rigby, David Thompson, Barbara Tomenson, North of England IBS Research Group
• Journal: Gastroenterology (Gastroenterology) Vol. 124 Issue 2 Pg. 303-17 (Feb 2003) ISSN: 0016-5085 [Print] United States
• PMID: 12557136 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Antidepressive Agents, Second-Generation
• Paroxetine

Topics

• Absenteeism
• Adult
• Antidepressive Agents, Second-Generation (therapeutic use)
• Colonic Diseases, Functional (physiopathology, therapy)
• Cost-Benefit Analysis
• Female
• Forecasting
• Health Care Costs
• Health Status
• Humans
• Male
• Middle Aged
• Multivariate Analysis
• Pain (physiopathology)
• Paroxetine (economics, therapeutic use)
• Patient Compliance
• Psychotherapy (economics)
• Quality of Life
• Severity of Illness Index
• Treatment Outcome