Cost-effectiveness of cognitive therapy as an early intervention for post-traumatic stress disorder in children and adolescents: a trial based evaluation and model.

James Shearer,Clare Dixon,Richard Meiser‐Stedman,Patrick Smith,Tim Dalgleish,Anna Mckinnon,Sarah Byford,Nestor Papanikolaou

doi:10.1111/jcpp.12851

Abstract

BackgroundUntreated post-traumatic stress disorder (PTSD) in children and adolescents is associated with a considerable economic burden on the health system, families and society. Recent research has demonstrated the potential efficacy of cognitive therapy as an early intervention for PTSD in children and adolescents. Children who experienced a single traumatic event in the previous two to six months and were randomized to cognitive therapy for PTSD (CT-PTSD) were significantly more likely to be PTSD-free compared to those randomized to usual care represented by waitlist control. The current study evaluated the economic impact of improvements in the treatment of PTSD in children and adolescents.MethodsA cost-effectiveness analysis was conducted from the national health service/personal social services perspective with outcomes expressed as quality-adjusted life years (QALYs). Patient level costs and outcomes were collected during the 11 week clinical trial and extrapolated to a three year time horizon using economic modelling methods. Uncertainty was estimated using probabilistic sensitivity analysis and assumptions were tested using one way sensitivity analysis.ResultsThe incremental cost-effectiveness ratio at 3 years was £2,205 per QALY with a 60%–69% probability of CT-PTSD being cost-effective compared to usual care at the UK £20,000 to £30,000 per QALY decision threshold.ConclusionsThis study provides preliminary evidence for the cost-effectiveness of cognitive therapy in this treatment population. Larger pragmatic trials with longer follow-up are indicated.

Highlights

In peace time, more than half of children and adolescents will experience, or witness, traumatic events such as violence, abuse, vehicle accidents, house fires, deaths and injuries (Copeland, Keeler, Angold, & Costello, 2007)
We systematically reviewed the cost effectiveness literature in childhood post-traumatic stress disorder (PTSD) and identified two published economic evaluations which modelled the cost-effectiveness of trauma-focussed cognitive behavioural therapy (TF-CBT) for childhood and adolescent PTSD (Gospodarevskaya & Segal, 2012; Mihalopoulos et al, 2015)
Training costs were excluded from the primary analysis because it was. This model-based cost utility analysis, using cost and quality-adjusted life years (QALYs) data collected from a randomized clinical trial extrapolated over the longer term, provides preliminary support that cognitive therapy for PTSD (CT-PTSD) may be costeffective from the UK National Health Service (NHS) perspective over a three year time horizon

Summary

Introduction

More than half of children and adolescents will experience, or witness, traumatic events such as violence, abuse, vehicle accidents, house fires, deaths and injuries (Copeland, Keeler, Angold, & Costello, 2007). The potential economic burden of untreated childhood and adolescent PTSD includes higher lifetime health care costs, impaired quality of life for patients and their families, educational difficulties and potentially poorer employment outcomes (Makley & Falcone, 2010). Untreated post-traumatic stress disorder (PTSD) in children and adolescents is associated with a considerable economic burden on the health system, families and society. Methods: A cost-effectiveness analysis was conducted from the national health service/personal social services perspective with outcomes expressed as quality-adjusted life years (QALYs). Patient level costs and outcomes were collected during the 11 week clinical trial and extrapolated to a three year time horizon using economic modelling methods.

Methods

Results

Conclusion