Atencion primaria · 2009
[Tree decision analysis of the therapeutic alternatives for Panic Disorders in Primary Care].
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Navarro-Mateu Fernando, Garriga-Puerto Ascensión, Sánchez-Sánchez Juan Antonio
Аннотация
AIMS: To analyse the different therapeutic alternatives for Panic Disorders to make it easier to make collaborative treatment decisions between patients and doctors in a Primary Care setting.
DESIGN: Quantitative analysis by a decision tree.
DATA SOURCES: Time period reviewed; 1990-2008 in Med-line, Embase, Cochrane-plus Library and Tripdatabase. Terms used "panic disorder", "psychotherapy" and "drug therapy".
METHODS: I) A decision tree was prepared with only one therapeutic option in each arm; II) The same procedure with two sequential therapeutic options; III) Sensitivity analysis to test the robustness of the model.
STUDY SELECTION: Evidence summary, systematic reviews, meta-analysis and clinical guidelines.
RESULTS: Cognitive-Behavioural Therapy (CBT) obtains the highest usefulness (UME=0.58), followed by the Selective serotonin reuptake inhibitors (SSRI) (UME=0.53) and by the tricyclic antidepressants (UME=0.44). CBT followed by SSRI is the therapeutic sequence with the highest usefulness (0.62). The sensitivity analysis suggests the model is not robust enough.
CONCLUSIONS: The CBT in monotherapy or followed by SSRI in a sequential strategy would be the options with the highest usefulness. The results are not robust enough because they can clearly vary with changes in the most important variables in a reasonable range.
DESIGN: Quantitative analysis by a decision tree.
DATA SOURCES: Time period reviewed; 1990-2008 in Med-line, Embase, Cochrane-plus Library and Tripdatabase. Terms used "panic disorder", "psychotherapy" and "drug therapy".
METHODS: I) A decision tree was prepared with only one therapeutic option in each arm; II) The same procedure with two sequential therapeutic options; III) Sensitivity analysis to test the robustness of the model.
STUDY SELECTION: Evidence summary, systematic reviews, meta-analysis and clinical guidelines.
RESULTS: Cognitive-Behavioural Therapy (CBT) obtains the highest usefulness (UME=0.58), followed by the Selective serotonin reuptake inhibitors (SSRI) (UME=0.53) and by the tricyclic antidepressants (UME=0.44). CBT followed by SSRI is the therapeutic sequence with the highest usefulness (0.62). The sensitivity analysis suggests the model is not robust enough.
CONCLUSIONS: The CBT in monotherapy or followed by SSRI in a sequential strategy would be the options with the highest usefulness. The results are not robust enough because they can clearly vary with changes in the most important variables in a reasonable range.