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

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.

Déclaration de conflit d'intérêts

IM, OMV, SS and SP received support from the National Collaborating Centre for Mental Health and the National Guideline Alliance, which were in receipt of funding from the National Institute for Health and Care Excellence (NICE), for the submitted work. CD, SD and NJW received support from the NICE Guidelines Technical Support Unit, University of Bristol, with funding from the Centre for Clinical Practice (NICE). SD and NJW were co-applicants on a grant (unrelated to this work) from the MRC Methodology Research Programme which included an MRC Industry Collaboration Agreement with Pfizer Ltd, who part-funded a researcher to work on statistical methodology in a project underlated to this work. This does not alter our adherence to PLOS ONE policies on sharing data and materials. GB is a coinvestigator on a NIHR RfPB grant, Eye Movement Desensitization and Reprocessing Therapy in Early Psychosis (EYES): A feasibility randomised controlled trial. NGreenberg is the Royal College of Psychiatrists Lead for Military and Veterans’ Health and is a trustee of two military charities. He is also a senior researcher with King’s College London working on a number of military mental health r studies. NGrey is a member of the Wellcome Trust Anxiety Disorders Group developing, testing and disseminating Cognitive Therapy for PTSD (CT-PTSD), a trauma-focused cognitive behavioural therapy (TF-CBT). He has published papers and book chapters on CT-PTSD, and facilitates teaching workshops for which payment is received. As editor, he receives royalties from sales of a trauma book, A Casebook of Cognitive Therapy for Traumatic Stress Reactions. CK is Medical Director of the Helen Bamber Foundation (a human rights charity) and refugee and asylum mental health lead for the Royal College of Psychiatrists. He writes expert psychiatric reports in the context of asylum mental health. JL is NHS England Medical Director for Military and Veterans Health. SP receives funding from NICE for the development of clinical guidelines and is also supported by the NIHR UCLH Biomedical Research Centre. The authors report no other relationships or activities that could appear to have influenced the submitted work.