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 6month period.Results: A total of 3549 patients were systematically recruited, 1815 in the DSM-IV criteria group (DG) and 1264 in the 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%respecttively, 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.