OBJECTIVES: Panic disorder (PD) is an anxiety disorder, which occurs frequently in patients presenting to a First Heart Aid (FHA) with chest pain and/or palpitations. Although the efficacy of pharmacological treatment for PD in a psychiatric population is high, an accepted standard treatment for PD in cardiac patients is not yet available. The objective of this study was to evaluate the cost-effectiveness of pharmacological treatment compared to care as usual in patients presenting with cardiac complaints to a FHA in whom PD was confirmed. METHODS: The design was a randomised double-blind placebo-controlled study with an intervention group receiving sertraline or placebo (IG; N = 62) and a care as usual group (CAUG; N = 44). The study was performed from the societal perspective with a time horizon of 24 weeks. Costs were calculated using cost diaries and hospital data. Primary endpoint was successful treatment, defined as reduction of = 50% of the number of panic attacks and/or a reduction of = 50% on the Hamilton Depression Rating Scale (HAMD). Secondary endpoint was health state utility, obtained by the EQ-5D, which was used to calculate QALYs. Incremental cost-effectiveness ratios (ICERs) were calculated for both endpoints. Subsequently, bootstrap analyses were performed (1000 replications) to quantify the uncertainty around the ICERs. RESULTS: Baseline characteristics were comparable for both groups. A total of 67.7% of the patients in the IG was treated successfully versus 43.2% in the CAUG (P = .017). Mean QALY in the IG was 0.30, versus 0.29 in the CAUG. The incremental costs amounted to €-1361.47 (-4060 - 1337) in favour of the IG. CONCLUSIONS: Based on this preliminary analysis with unblinded data both ICERs indicated a dominance for IG. This was confirmed by the bootstrap results, with 84.1% and 66.7% of the cost-effectiveness pairs, based on respectively the primary and secondary endpoints, lying in the southeast quadrant.