Cost-effectiveness of psychological treatments for post-traumatic stress disorder in adults.

Ifigeneia Mavranezouli,Neil Greenberg,Sofia Dias,Nicky J Welton,Gita Bhutani,Cornelius Katona,Sarah Stockton,Stephen Pilling,Nick Grey,Jonathan Leach,Sharif El-Leithy,Caitlin Daly,Odette Megnin-Viggars

doi:10.1371/journal.pone.0232245

Abstract

Post-traumatic stress disorder (PTSD) is a severe and disabling condition that may lead to functional impairment and reduced productivity. Psychological interventions have been shown to be effective in its management. The objective of this study was to assess the cost-effectiveness of a range of interventions for adults with PTSD. A decision-analytic model was constructed to compare costs and quality-adjusted life-years (QALYs) of 10 interventions and no treatment for adults with PTSD, from the perspective of the National Health Service and personal social services in England. Effectiveness data were derived from a systematic review and network meta-analysis. Other model input parameters were based on published sources, supplemented by expert opinion. Eye movement desensitisation and reprocessing (EMDR) appeared to be the most cost-effective intervention for adults with PTSD (with a probability of 0.34 amongst the 11 evaluated options at a cost-effectiveness threshold of £20,000/QALY), followed by combined somatic/cognitive therapies, self-help with support, psychoeducation, selective serotonin reuptake inhibitors (SSRIs), trauma-focused cognitive behavioural therapy (TF-CBT), self-help without support, non-TF-CBT and combined TF-CBT/SSRIs. Counselling appeared to be less cost-effective than no treatment. TF-CBT had the largest evidence base. A number of interventions appear to be cost-effective for the management of PTSD in adults. EMDR appears to be the most cost-effective amongst them. TF-CBT has the largest evidence base. There remains a need for well-conducted studies that examine the long-term clinical and cost-effectiveness of a range of treatments for adults with PTSD.

Highlights

A considerable proportion of people exposed to trauma, around 5.6%, will develop post-traumatic stress disorder (PTSD) [1]
There remains a need for well-conducted studies that examine the longterm clinical and cost-effectiveness of a range of treatments for adults with Post-traumatic stress disorder (PTSD)
The study population comprised adults presenting in primary care with clinically important post-traumatic stress symptoms, defined by a diagnosis of PTSD according to the Diagnostic and Statistical Manual of Mental Disorders (DSM), the World Health Organization (WHO) International Classification of Diseases (ICD) or similar criteria, or by clinically significant PTSD symptoms, indicated by a PTSD symptom score above threshold on a validated scale, that are present for more than 3 months after a traumatic event

Summary

Introduction

A considerable proportion of people exposed to trauma, around 5.6%, will develop post-traumatic stress disorder (PTSD) [1]. PTSD is a severe and disabling condition that may lead to functional impairment and reduced productivity [2]. Given the variety of available interventions and the need for efficient use of healthcare resources, the objective of this study was to examine the cost-effectiveness of a range of psychological interventions for the treatment of PTSD in adults from the perspective of the National Health Service (NHS) and Personal Social Services (PSS) in England, using decision-analytic economic modelling. Post-traumatic stress disorder (PTSD) is a severe and disabling condition that may lead to functional impairment and reduced productivity.

Objectives

Methods

Results

Conclusion