Ifigeneia Mavranezouli1,2, Odette Megnin-Viggars1,2, Nick Grey3,4, Gita Bhutani5,6, Jonathan Leach7, Caitlin Daly8, Sofia Dias8, Nicky J Welton8, Cornelius Katona9,10, Sharif El-Leithy11, Neil Greenberg12, Sarah Stockton2, Stephen Pilling1,2,13. 1. Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational & Health Psychology, University College London, London, United Kingdom. 2. National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, United Kingdom. 3. Sussex Partnership NHS Foundation Trust, Hove, United Kingdom. 4. School of Psychology, University of Sussex, Brighton, United Kingdom. 5. Lancashire & South Cumbria NHS Foundation Trust, Preston, United Kingdom. 6. University of Liverpool, Liverpool, United Kingdom. 7. Davenal House Surgery, Bromsgrove, United Kingdom. 8. Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom. 9. Helen Bamber Foundation, London, United Kingdom. 10. Division of Psychiatry, University College London, London, United Kingdom. 11. Traumatic Stress Service, Springfield Hospital, London, United Kingdom. 12. King's Centre for Military Health Research, King's College London, London, United Kingdom. 13. Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, United Kingdom.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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