Abstract
Background
Anxiety disorders (AD) are common mental disorders, for which several cost-of-illness (COI) studies have been conducted in the past.
Objective
The aim of this review was to provide a systematic overview of these studies and an aggregation of their results.
Methods
A systematic literature search limited to studies published after 1999 was conducted in PubMed/MEDLINE in November 2018. We included top-down COI studies reporting costs for AD, and bottom-up COI studies reporting costs for AD and a non-diseased control group, and extracted data manually. Results of the top-down COI studies were aggregated by calculating the mean percentage of costs on gross domestic product (GDP) and health expenditure, while the results of the bottom-up studies were analyzed meta-analytically using the ‘ratio of means’ method and inverse-variance pooling. In this review, the logarithm of the relative difference in a continuous outcome between two groups is calculated and aggregated over the studies. The results can be interpreted as the relative change in costs imposed by a specific disease compared with baseline costs.
Results
We identified 13 top-down and 11 bottom-up COI studies. All top-down COI studies and four bottom-up COI studies reported costs for AD as a diagnostic group, four for generalized anxiety disorder (GAD), four for social anxiety disorder (SAD), and one for panic disorder. In top-down COI studies, direct costs of AD, on average, corresponded to 2.08% of health care costs and 0.22% of GDP, whereas indirect costs, on average, corresponded to 0.23% of GDP. In bottom-up COI studies, direct costs of patients with AD were increased by factor 2.17 (1.29–3.67; p = 0.004) and indirect costs were increased by factor 1.92 (1.05–3.53; p = 0.04), whereas total costs increased by factor 2.52 (1.73–3.68; p < 0.001). Subgroup analysis revealed an increase in direct costs by 1.60 (1.16–2.22; p = 0.005) for SAD and 2.60 (2.01–3.36; p < 0.001) for GAD. Measures of heterogeneity indicated high heterogeneity when pooling studies for direct costs, indirect costs, and total costs, but low to moderate heterogeneity when pooling studies for SAD or GAD.
Conclusions
Using methods that focused on relative rather than absolute costs, we were able to aggregate costs reported in different COI studies for ADs. We found that ADs were associated with a low proportion of health care costs on a population level, but significantly increased health care costs on an individual level compared with healthy controls. Our disorder-specific subgroup analysis showed that study findings are most homogeneous within specific ADs. Therefore, to get a more detailed picture of the costs of ADs, more studies for currently under researched ADs, such as panic disorder, are needed.
Similar content being viewed by others
Data Availability Statement
Data underlying the analysis of this study were either extracted from the included studies or taken from the OECD Health Data database. The authors do not have proprietary rights on any of these data.
References
GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1211–1259.
Wittchen HU, et al. The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol. 2011;21(9):655–79.
Bandelow B, Michaelis S. Epidemiology of anxiety disorders in the 21st century. Dial Clin Neurosci. 2015;17(3):327–35.
Fineberg NA, et al. The size, burden and cost of disorders of the brain in the UK. J Psychopharmacol. 2013;27(9):761–70.
Gustavsson A, et al. Cost of disorders of the brain in Europe 2010. Eur Neuropsychopharmacol. 2011;21(10):718–79.
Maercker A, et al. The costs of disorders of the brain in Switzerland: an update from the European Brain Council Study for 2010. Swiss Med Wkly. 2013;143:w13751.
Olesen J, et al. Cost of disorders of the brain in Denmark. Nord J Psychiatry. 2008;62(2):114–20.
Pugliatti M, et al. Cost of disorders of the brain in Italy. Neurol Sci. 2008;29(2):99–107.
Schoenen J, et al. Cost estimates of brain disorders in Belgium. Acta Neurol Belg. 2006;106(4):208–14.
Stovner LJ, et al. Cost of disorders of the brain in Norway. Acta Neurol Scand Suppl. 2010;190:1–5.
Wancata J, Sobocki P, Katschnig H. Cost of disorders of the brain in Austria in the year 2004 [in German]. Wien Klin Wochenschr. 2007;119(3–4):91–8.
OECD. OECD Health Statistics 2018. Available at: http://www.oecd.org/els/health-systems/health-data.htm. Accessed 29 Jun 2018.
Friedrich JO, Adhikari NK, Beyene J. The ratio of means method as an alternative to mean differences for analyzing continuous outcome variables in meta-analysis: a simulation study. BMC Med Res Methodol. 2008;8:32.
Friedrich JO, Adhikari NK, Beyene J. Ratio of geometric means to analyze continuous outcomes in meta-analysis: comparison to mean differences and ratio of arithmetic means using empiric data and simulation. Stat Med. 2012;31(17):1857–86.
DuPont RL, et al. Economic costs of anxiety disorders. Anxiety. 1996;2(4):167–72.
Greenberg PE, et al. The economic burden of anxiety disorders in the 1990s. J Clin Psychiatry. 1999;60(7):427–35.
Sado M, et al. Cost of anxiety disorders in Japan in 2008: a prevalence-based approach. BMC Psychiatry. 2013;13:338.
Shirneshan E, et al. Incremental direct medical expenditures associated with anxiety disorders for the U.S. adult population: evidence from the Medical Expenditure Panel Survey. J Anxiety Disord. 2013;27(7):720–7.
Sillanpää M, Andlin-Sobocki P, Lonnqvist J. Costs of brain disorders in Finland. Acta Neurol Scand. 2008;117(3):167–72.
Huang CJ, et al. Health care utilization and expenditures of persons with diabetes comorbid with anxiety disorder: a national population-based cohort study. Gen Hosp Psychiatry. 2015;37(4):299–304.
Acarturk C, et al. Economic costs of social phobia: a population-based study. J Affect Disord. 2009;115(3):421–9.
Dams J, et al. Excess costs of social anxiety disorder in Germany. J Affect Disord. 2017;213:23–9.
Marciniak M, et al. Medical and productivity costs of anxiety disorders: case control study. Depress Anxiety. 2004;19(2):112–20.
Olfson M, Gameroff MJ. Generalized anxiety disorder, somatic pain and health care costs. Gen Hosp Psychiatry. 2007;29(4):310–6.
Patel A, et al. The economic consequences of social phobia. J Affect Disord. 2002;68(2–3):221–33.
Rees CS, Richards JC, Smith LM. Medical utilisation and costs in panic disorder: a comparison with social phobia. J Anxiety Disord. 1998;12(5):421–35.
Rovira J, et al. The cost of generalized anxiety disorder in primary care settings: results of the ANCORA study. Community Ment Health J. 2012;48(3):372–83.
Rutledge T, et al. Anxiety associations with cardiac symptoms, angiographic disease severity, and healthcare utilization: the NHLBI-sponsored Women’s Ischemia Syndrome Evaluation. Int J Cardiol. 2013;168(3):2335–40.
Toghanian S, et al. Economic and humanistic burden of illness in generalized anxiety disorder: an analysis of patient survey data in Europe. Clinicoecon Outcomes Res. 2014;6:151–63.
Vasiliadis HM, et al. The excess healthcare costs associated with depression and anxiety in elderly living in the community. Am J Geriatr Psychiatry. 2013;21(6):536–48.
Drost R, et al. Conceptualizations of the societal perspective within economic evaluations: a systematic review. Int J Technol Assess Health Care. 2017;33(2):251–60.
Author information
Authors and Affiliations
Contributions
AK planned the review, conducted the literature search, extracted information, conducted analyses of top-down COI studies, and prepared the manuscript. HK conducted meta-analysis of bottom-up COI studies, prepared respective parts of the manuscript, and critically revised the manuscript prior to submission. Both AK and HK revised the manuscript after peer review. The authors thank Marc Martin for proofreading this manuscript.
Corresponding author
Ethics declarations
Funding
No funding was received for this study.
Conflicts of interest
Alexander Konnopka and Hannah König have no conflicts interest to declare.
Ethical Approval
This article does not contain any studies with human participants or animals performed by any of the authors.
Additional information
Alexander Konnopka and Hannah König share first authorship of this work.
Rights and permissions
About this article
Cite this article
Konnopka, A., König, H. Economic Burden of Anxiety Disorders: A Systematic Review and Meta-Analysis. PharmacoEconomics 38, 25–37 (2020). https://doi.org/10.1007/s40273-019-00849-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40273-019-00849-7