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Open Access Research article

Healthcare utilization and costs in patients beginning pharmacotherapy for generalized anxiety disorder: a retrospective cohort study

Ariel Berger1*, John Edelsberg1, Vamsi Bollu2, Jose Ma J Alvir3, Ashish Dugar3, Ashish V Joshi3 and Gerry Oster1

Author Affiliations

1 Policy Analysis Inc. (PAI), Four Davis Court, Brookline, MA, 02445, USA

2 Novartis Pharmaceuticals Corporation, Bldg 432/554-2D, One Health Plaza, East Hanover, NJ, 07045 USA

3 Pfizer Inc., 235 East 42nd Street, New York, NY, 10017, USA

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BMC Psychiatry 2011, 11:193  doi:10.1186/1471-244X-11-193

Published: 12 December 2011



Patterns of healthcare utilization and costs in patients beginning pharmacotherapy for generalized anxiety disorder (GAD) have not been well characterized.


Using a large US health insurance database, we identified all patients with evidence of GAD (ICD-9-CM diagnosis code 300.02) who initiated pharmacotherapy with medications commonly used to treat GAD (eg, selective serotonin reuptake inhibitors [SSRIs], venlafaxine, benzodiazepines) between 1/1/2003 and 12/31/2007. We examined healthcare utilization and costs over the 12-month periods preceding and following date of initial receipt of such therapy ("pretreatment" and "follow-up", respectively). Patients with incomplete data were excluded.


A total of 10,275 patients met all study inclusion criteria. Forty-eight percent of patients received SSRIs; 34%, benzodiazepines; and 6%, venlafaxine. SSRIs and venlafaxine were about three times more likely to be used on a long-term basis (> 90 days) than benzodiazepines (p < 0.01). In general, levels of healthcare utilization were higher during follow-up than pretreatment. Mean (SD) total healthcare costs increased from $4812 ($10,006) during pretreatment to $7182 ($22,041) during follow-up (p < 0.01); costs of GAD-related pharmacotherapy during follow-up were $420 ($485).


More than one-half of patients initiating pharmacotherapy for GAD receive either SSRIs or venlafaxine. Levels of healthcare utilization and costs are greater in the year following initiation of therapy than in the immediately preceding one.