The effect of broadening the definition of generalized anxiety disorder on healthcare resource utilization and related costs in outpatient psychiatric clinics
Background: Patients with generalized
anxiety disorder (GAD) are among the highest users of healthcare resources. The
broadening of the DSM-IV criteria for GAD has been a subject of controversy in
the literature, but its consequences have not been analyzed to date. Objective:
The purpose of this study was to analyze how the broadening of the DSM-IV
criteria affects healthcare resource utilization and related costs. Methods: A
multicentre, prospective, observational study was conducted in randomly selected
outpatient psychiatric clinics between October 2007 and April 2008. Patients
diagnosed according to DSM-IV or broader criteria (1 month of excessive or
non-excessive worry and only 2 associated DSM-IV symptoms) for the first time
were consecutively enrolled. Socio-demographic data, healthcare resources and
corresponding costs were collected over a 6-month period. Results: A total of 3549
patients were systematically recruited, 1815 in the DSM-IV criteria group
(DG) and1264 inthe broad
criteria group (BG). Treatments prescribed were similar for antidepressants in
both groups (77.0% in the DG vs. 75.3% in the BG, p = 0.284), and slightly
higher in the DG for benzodiazepines (71.5% vs. 67.2% respectively, p = 0.011)
and anticonvulsants (72.1% vs. 67.0% respectively, p = 0.002). Healthcare
resource utilization was statistically reduced to a similar extent in both
groups as a consequence of treatment, yielding a reduction in the cost of
illness of €1196 (SD = 1158) and €1112 (SD = 874) respectively; p = 0.304, over
a 6-month period. Conclusion: The broadening of the GAD criteria could lead to
earlier diagnosis not necessarily associated with an increase in healthcare
resource utilization or costs to the National Health System in the six-month
follow-up.
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