Economic and humanistic burden of illness in generalized anxiety disorder: an analysis of patient survey data in Europe

Figures & data

Table 1 Patient demographics, disease characteristics, and health status

Demographics, disease characteristics, and health status	GAD patients n=3,669	Non-GAD controls n=3,669	Cohen’s d/φ	t/χ^2	P-value
Age, years			0.06	−2.44	0.015
Mean ± SD	46.49±13.48	45.72±13.48
Mean (95% CI)	46.49 (46.05–46.93)	45.72 (45.29–46.16)
Median (range)	47.00 (18.00–82.00)	47.00 (18.00–86.00)
Sex, n (%)			0.00	0.01	0.941
Male	1,245 (33.9)	1,242 (33.9)
Female	2,424 (66.1)	2,427 (66.1)
Married, n (%)			−0.02	3.49	0.062
Not married	1,928 (52.5)	1,848 (50.4)
Married	1,741 (47.5)	1,821 (49.6)
Employment, n (%)			0.07	38.70	<0.001
Employed	1,971 (53.7)	2,195 (59.8)
Retired	130 (3.5)	155 (4.2)
On disability	298 (8.1)	285 (7.8)
Other	1,270 (34.6)	1,034 (28.2)
Alcohol, n (%)			−0.03	7.42	0.006
Do not drink alcohol	940 (25.6)	840 (22.9)
Drink alcohol	2,729 (74.4)	2,829 (77.1)
Smoking, n (%)			0.07	35.87	<0.001
Do not smoke	2,301 (62.7)	2,544 (69.3)
Currently smoke	1,368 (37.3)	1,125 (30.7)
Exercise per month, days			0.05	2.16	0.031
Mean ± SD	5.35±7.59	5.74±7.97
Mean (95% CI)	5.35 (5.10–5.59)	5.74 (5.48–6.00)
Median (range)	1.00 (0.00–31.00)	2.00 (0.00–31.00)
Comorbidity count			1.20	−51.17	<0.001
Mean ± SD	10.68±5.37	4.93±4.17
Mean (95% CI)	10.68 (10.50–10.85)	4.93 (4.80–5.07)
Median (range)	10.00 (2.00–94.00)	4.00 (0.00–34.00)
MCS score^Citation22			0.99	42.56	<0.001
Mean ± SD	34.89±10.61	45.53±10.81
Mean (95% CI)	34.89 (34.54–35.23)	45.53 (45.18–45.88)
Median (range)	34.87 (0.60–69.16)	46.56 (6.26–77.09)
PCS score^Citation22			0.23	9.73	<0.001
Mean ± SD	45.62±11.60	48.19±10.96
Mean (95% CI)	45.62 (45.25–46.00)	48.19 (47.83–48.54)
Median (range)	47.48 (8.60–71.09)	51.29 (6.27–70.98)
Health utilities score^Citation24			1.00	37.52	<0.001
Mean ± SD	0.61±0.10	0.71±0.13
Mean (95% CI)	0.61 (0.61–0.61)	0.71 (0.71–0.72)
Median (range)	0.62 (0.35–1.00)	0.66 (0.35–1.00)

Notes: Patient population comprised patients with a diagnosis of GAD and non-GAD controls from France, Germany, Italy, Spain, and the UK. Control group had no specific GAD diagnosis (self-report) but could have reported another anxiety disorder (eg, social anxiety disorder, panic disorder). Cohen’s d (for continuous variables) and the phi coefficient (φ, for categorical variables) were used as measures of effect size.

Abbreviations: CI, confidence interval; GAD, generalized anxiety disorder; MCS, mental health component summary; PCS, physical component summary; SD, standard deviation.

Figure 1 Impairment in work productivity and daily activities in patients with GAD.

Notes: *P<0.05; **P<0.01; ***P<0.001 GAD patients versus non-GAD controls. Rate ratio >1 indicates the mean value for GAD patients is higher than for non-GAD controls. Europe overall refers to the five European countries included in this study. Data from across five European countries (France, Germany, Italy, Spain, and the UK) and within each country.
Abbreviation: GAD, generalized anxiety disorder.

Figure 2 Difference in health care resource utilization in patients with GAD and non-GAD controls.

Notes: Data shown are for (A) likelihood of visiting traditional and nontraditional health care providers and (B) type of health care interaction. *P<0.05; **P<0.01; ***P<0.001 GAD patients versus non-GAD controls. Rate ratio >1 indicates the mean value for GAD patients is higher than for non-GAD controls; rate ratio >1 indicates the mean value for GAD patients is lower than for non-GAD controls. Europe overall refers to the five European countries included in this study.
Abbreviations: ER, emergency room; GAD, generalized anxiety disorder; HCP, health care provider.

Table 2 Average direct and indirect costs per patient with GAD per year

Cost component	GAD patients n=3,669	Non-GAD controls n=3,669	Mean difference (95% CI)
Direct costs (€)
Medication	41.79	2.95	38.84 (35.70–41.98)
Emergency room visits	61.67	32.90	28.77 (19.53–38.02)
Hospitalizations	619.09	235.31	383.78 (266.80–500.80)
General/family practitioner visits	159.19	90.19	69.00 (61.90–76.12)
Psychologist/psychiatrist visits	164.97	25.97	139.00 (120.60–157.40)
Total direct costs	1,046.71	387.32	659.39 (534.30–784.50)
Indirect costs (€)
Absenteeism	1,510.30	590.27	920.03 (711–1,129)
Presenteeism	2,751.80	1,463.50	1,288.30 (1,079–1,498)
Total indirect costs	4,262.10	2,053.77	2,208.33 (1,900–2,517)
Total costs (€)	5,308.81	2,441.09	2,867.72 (2,526–3,210)

Note: Data from France, Germany, Italy, Spain, and the UK.

Abbreviations: CI, confidence interval; GAD, generalized anxiety disorder.

Figure 3 Average direct and indirect costs per patient with GAD per year.

Notes: Data from across France, Germany, Italy, Spain, and the UK (mean difference between patients with GAD and non-GAD controls) showing (A) direct costs and (B) indirect costs. ***P<0.001 GAD patients versus non-GAD controls.
Abbreviation: GAD, generalized anxiety disorder.

Figure 4 Health care costs of GAD by GAD severity.

Notes: Data show (A) average total costs per patient with GAD per year by GAD severity across five European countries (France, Germany, Italy, Spain, and the UK) and (B) mean difference in total costs for patients with GAD versus non-GAD controls by GAD severity within the five European countries. *P<0.05; **P<0.01; ***P<0.001 GAD patients versus non-GAD controls.
Abbreviation: GAD, generalized anxiety disorder.

Table 3 Decreases in estimated costs associated with improvements in HRQoL per patient per year

Cost component	Estimated cost change per 0.01 increase in utility score (€ [95% CI])
	GAD patients	Non-GAD control
Direct costs	−53.34 (−65.07, −41.60)	−22.47 (−26.04, −18.91)
Indirect costs	−118.02 (−144.08, −91.96)	−68.74 (−81.38, −56.11)
Total costs	−171.36 (−200.49, −142.23)	−91.21 (−104.64, −77.79)

Abbreviations: CI, confidence interval; GAD, generalized anxiety disorder; HRQoL, health-related quality of life.

Table S1 Patient demographics and disease characteristics within five European countries

Demographics	France			Germany			UK			Italy			Spain
	GAD n=1,418	Non-GAD controls n=1,217	Mean difference (95% CI)	GAD n=218	Non-GAD controls n=216	Mean difference (95% CI)	GAD n=1,055	Non-GAD control n=1,245	Mean difference (95% CI)	GAD n=730	Non-GAD controls n=739	Mean difference (95% CI)	GAD n=248	Non-GAD controls n=252	Mean difference (95% CI)
Mean (SD) age, years	45.6 (13.2)	42.4 (12.1)	−3.18 (−4.15, −2.20)	44.3 (13.1)	43.7 (12.7)	−0.67 (−3.10, 1.77)	46.9 (13.5)	48.8 (13.6)	1.95 (0.84, 3.06)	48.7 (13.8)	47.2 (14.1)	−1.44 (−2.87, −0.02)	45.7 (13.2)	44.0 (13.9)	−1.75 (−4.13, 0.63)
Male, %	26.0	25.1	–	41.7	41.7	–	38.3	38.3	–	40.1	38.3	–	35.5	34.5	–
Married, %	43.1	41.7	–	33.5	43.1	–	46.8	54.6	–	59.2	56.2	–	52.8	49.6	–
Employment status, %						–			–			–			–
Employed	50.9	61.6	–	45.9	49.1		48.0	56.8		65.1	65.8		68.2	57.9
Retired	16.2	2.8		18.4	14.8		17.1	13.7		18.1	13.8		11.3	11.5
On disability	6.8	7.1		7.3	5.1		16.6	14.1		0.1	0.0		3.6	4.8
Other	26.2	28.5		28.4	31.0		18.4	15.3		16.7	20.4		16.9	25.8
Alcohol user, %	74.3	75.8	–	71.6	77.8	–	80.5	84.2	–	70.1	68.3	–	64.1	73.8	–
Current smoker, %	39.6	35.1	–	41.7	39.8	–	33.7	26.2	–	34.3	27.6	–	44.4	32.5	–
Mean (SD) days exercised per month	5.2 (7.6)	5.5 (7.8)	0.26 (−0.33, 0.85)	4.3 (6.6)	5.3 (7.2)	1.04 (−0.26, 2.34)	5.5 (7.7)	6.0 (8.3)	0.47 (−0.19, 1.12)	5.6 (7.6)	5.3 (7.5)	−0.32 (−1.1, 0.46)	5.5 (8.0)	7.4 (8.8)	1.92 (0.45, 3.40)
Comorbidity count	9.9 (4.4)	4.3 (3.8)	−5.53 (−5.84, −5.21)	14.6 (7.9)	5.5 (4.4)	−9.06 (−10.27, −7.84)	11.4 (5.0)	5.8 (4.4)	−5.63 (−6.01, −5.24)	10.5 (6.3)	4.6 (4.2)	−5.9 (−6.44, −5.35)	9.4 (4.7)	4.2 (3.4)	−5.26 (−5.98, −4.54)

Note: Control group had no specific GAD diagnosis (self-report) but could have reported another anxiety disorder (eg, social anxiety disorder, panic disorder).

Abbreviations: CI, confidence interval; GAD, generalized anxiety disorder; SD, standard deviation.

Table S2 HRQoL scores within five European countries

HRQoL score	France			Germany			UK			Italy			Spain
	GAD n=1,418	Non-GAD controls n=1,217	Mean difference (95% CI)	GAD n=218	Non-GAD controls n=216	Mean difference (95% CI)	GAD n=1,055	Non-GAD controls n=1,245	Mean difference (95% CI)	GAD n=730	Non-GAD controls n=739	Mean difference (95% CI)	GAD n=248	Non-GAD controls n=252	Mean difference (95% CI)
PCS score,^Citation22 mean (SD)	46.5 (11.1)	49.9 (10.2)	3.38 (2.55, 4.20)	42.4 (11.2)	47.3 (10.9)	4.88 (2.79, 6.96)	43.9 (13.3)	45.5 (12.6)	1.62 (0.55, 2.68)	47.5 (9.5)	49.7 (8.7)	2.21 (1.28, 3.14)	45.0 (11.1)	49.3 (8.7)	4.34 (2.59, 6.09)
MCS score,^Citation22 mean (SD)	33.5 (10.1)	44.6 (10.6)	11.12 (10.33, 11.91)	32.3 (10.9)	46.5 (12.0)	14.16 (12.00, 16.32)	35.2 (11.7)	46.4 (11.3)	11.17 (10.23, 12.12)	36.1 (9.3)	44.2 (10.1)	8.05 (7.06, 9.05)	40.1 (9.9)	48.9 (9.5)	8.81 (7.10, 10.51)
Health utilities score,^Citation24 mean (SD)	0.6 (0.1)	0.7 (0.1)	0.11 (0.10, 0.12)	0.6 (0.1)	0.7 (0.1)	0.13 (0.11, 0.15)	0.6 (0.1)	0.7 (0.2)	0.11 (0.09, 0.12)	0.6 (0.1)	0.7 (0.1)	0.07 (0.06, 0.08)	0.6 (0.1)	0.8 (0.1)	0.12 (0.10, 0.14)

Note: Control group had no specific GAD diagnosis (self-report) but could have reported another anxiety disorder (eg, social anxiety disorder, panic disorder).

Abbreviations: CI, confidence interval; GAD, generalized anxiety disorder; HRQoL, health-related quality of life; MCS, mental health component summary; PCS, physical component summary; SD, standard deviation.

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