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

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 int...

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Vydáno v:	PloS one Ročník 15; číslo 4; s. e0232245
Hlavní autoři:	Mavranezouli, Ifigeneia, Megnin-Viggars, Odette, Grey, Nick, Bhutani, Gita, Leach, Jonathan, Daly, Caitlin, Dias, Sofia, Welton, Nicky J., Katona, Cornelius, El-Leithy, Sharif, Greenberg, Neil, Stockton, Sarah, Pilling, Stephen
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States Public Library of Science 2020 Public Library of Science (PLoS)
Témata:	Adult Adults Age Cognitive ability Cognitive behavioral therapy Cognitive Behavioral Therapy - methods Cognitive therapy Cost analysis Cost-Benefit Analysis Counseling Decision analysis Desensitization Economic models England Eye Movement Desensitization Reprocessing - methods Eye movements Female Gynecology Health psychology Health sciences Humans Male Mathematical models Medicine and Health Sciences Mental disorders People and Places Physical Sciences Population Post traumatic stress disorder Posttraumatic stress disorder Psychological stress Psychotherapy Psychotherapy - methods Quality-Adjusted Life Years Reprocessing Selective Serotonin Reuptake Inhibitors - therapeutic use Self help Serotonin Serotonin uptake inhibitors Social Sciences Social services State Medicine Stress Disorders, Post-Traumatic - drug therapy Stress Disorders, Post-Traumatic - psychology Trauma England United Kingdom > UK
ISSN:	1932-6203, 1932-6203
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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.
AbstractList	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. 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. 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. BackgroundPost-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.MethodsA 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.ResultsEye 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.ConclusionsA 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. 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.BACKGROUNDPost-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.METHODSA 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.RESULTSEye 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.CONCLUSIONSA 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.
Author	Megnin-Viggars, Odette Katona, Cornelius Leach, Jonathan Greenberg, Neil Stockton, Sarah Grey, Nick El-Leithy, Sharif Bhutani, Gita Mavranezouli, Ifigeneia Dias, Sofia Pilling, Stephen Welton, Nicky J. Daly, Caitlin
AuthorAffiliation	1 Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational & Health Psychology, University College London, London, United Kingdom 12 King’s Centre for Military Health Research, King’s College London, London, United Kingdom 5 Lancashire & South Cumbria NHS Foundation Trust, Preston, United Kingdom 10 Division of Psychiatry, University College London, London, United Kingdom 2 National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, United Kingdom 4 School of Psychology, University of Sussex, Brighton, United Kingdom 3 Sussex Partnership NHS Foundation Trust, Hove, United Kingdom 6 University of Liverpool, Liverpool, United Kingdom 11 Traumatic Stress Service, Springfield Hospital, London, United Kingdom Hunter Holmes McGuire VA Medical Center, UNITED STATES 8 Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom 13 Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, Un
AuthorAffiliation_xml	– name: 7 Davenal House Surgery, Bromsgrove, United Kingdom – name: Hunter Holmes McGuire VA Medical Center, UNITED STATES – name: 8 Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom – name: 4 School of Psychology, University of Sussex, Brighton, United Kingdom – name: 6 University of Liverpool, Liverpool, United Kingdom – name: 2 National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, United Kingdom – name: 5 Lancashire & South Cumbria NHS Foundation Trust, Preston, United Kingdom – name: 1 Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational & Health Psychology, University College London, London, United Kingdom – name: 13 Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, United Kingdom – name: 11 Traumatic Stress Service, Springfield Hospital, London, United Kingdom – name: 12 King’s Centre for Military Health Research, King’s College London, London, United Kingdom – name: 9 Helen Bamber Foundation, London, United Kingdom – name: 3 Sussex Partnership NHS Foundation Trust, Hove, United Kingdom – name: 10 Division of Psychiatry, University College London, London, United Kingdom
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BackLink	https://www.ncbi.nlm.nih.gov/pubmed/32353011$$D View this record in MEDLINE/PubMed
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Copyright	2020 Mavranezouli et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. 2020 Mavranezouli et al 2020 Mavranezouli et al
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DocumentTitleAlternate	Cost-effectiveness of psychological treatments for PTSD in adults
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Notes	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 Competing Interests: 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. Current address: Centre for Reviews and Dissemination, University of York, York, United Kingdom
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Snippet	Post-traumatic stress disorder (PTSD) is a severe and disabling condition that may lead to functional impairment and reduced productivity. Psychological... Background Post-traumatic stress disorder (PTSD) is a severe and disabling condition that may lead to functional impairment and reduced productivity.... BackgroundPost-traumatic stress disorder (PTSD) is a severe and disabling condition that may lead to functional impairment and reduced productivity.... Background Post-traumatic stress disorder (PTSD) is a severe and disabling condition that may lead to functional impairment and reduced productivity....
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Title	Cost-effectiveness of psychological treatments for post-traumatic stress disorder in adults
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