Both psychotherapy and paroxetine are cost-effective for the treatment of severe irritable bowel syndrome

Sivagnanam, S.
Louon, A

Dept of Anaesthesia; Sultan Qaboos University Hospital, Oman (Sivagnanam)
Dept of Anaesthesia; Hamad Medical Corporation, Qatar (Louon)

Abstracted from:Creed F, Fernades L, Guthrie E et al. The cost effectiveness of psychotherapy and paroxetine for severe irritable bowel syndrome. Gastroenterology 2003; 124: 303-317 .

Sources of funding: Supported by the Medical Research Council of the United Kingdom and the North Western Region Health Authority.

Correspondence to: F Creed, School of Psychiatry and Behavioural Science, Rawnsley Building, Oxford Road, Manchester M13 9WL, England. Email: [email protected].

Abstract provided by Bazian Ltd, London

Evidence-based Healthcare 7(3):p 151-153, September 2003.

BACKGROUND

Irritable bowel syndrome (IBS) is associated with significant impairments in the quality of life and a high prevalence of anxiety and depressive disorders. Treatment with both psychotherapy and anti-depressant drugs has been shown to be effective treatments for severe IBS, although little is known about the comparative cost-effectiveness of such treatments.

OBJECTIVE

To assess the cost-effectiveness of individual psychotherapy and the antidepressant paroxetine as treatments for severe irritable bowel syndrome.

SETTING

Seven gastroenterology clinics around Manchester and Sheffield in England. Recruitment from October 1994 to October 1997.

METHOD

Randomised controlled trial.

PARTICIPANTS

Two hundred and fifty-seven people, 29% of whom had diarrhea-predominant IBS, 23% had constipation-predominant IBS and 48% had general IBS.

INTERVENTION

Either psychotherapy (comprising one individual session of approximately 2 hours duration and seven individual sessions of approximately 45 minutes, over 3 months), or paroxetine (20 mg daily for 3 months), or treatment as usual provided by the gastroenterologist or general practitioner. Follow-up occurred over 15 months.

MAIN OUTCOMES

Measures of abdominal pain, health-related quality of life (SF-36 test) and health-care costs.

MAIN RESULTS

There was no significant difference between groups in either pain severity or frequency of abdominal pain at 1 year follow-up (Table 1). Both psychotherapy and paroxetine were significantly better than treatment as usual at improving the physical component of health-related quality of life (p<0.001). Direct health-care costs incurred during the treatment period were significantly greater for psychotherapy, but not paroxetine, compared with treatment as usual. However, over the 12-month follow-up period, healthcare costs were lower for both psychotherapy and paroxetine compared with treatment as usual.

Table 1 Primary outcome measures for psychotherapy, paroxetine and usual treatment groups over 3 time periods.
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AUTHORS' CONCLUSIONS

Both psychotherapy and paroxetine are cost-effective for the treatment of severe IBS.