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Health–economic benefits of treating trauma in psychosis

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posted on 21.09.2021, 10:22 authored by Paul A. J. M. de Bont, Berber M. van der Vleugel, David P. G. van den Berg, Carlijn de Roos, Joran Lokkerbol, Filip Smit, Ad de Jongh, Mark van der Gaag, Agnes van Minnen

Background: Co-occurrence of posttraumatic stress disorder (PTSD) in psychosis (estimated as 12%) raises personal suffering and societal costs. Health–economic studies on PTSD treatments in patients with a diagnosis of a psychotic disorder have not yet been conducted, but are needed for guideline development and implementation. This study aims to analyse the cost-effectiveness of guideline PTSD therapies in patients with a psychotic disorder.

Methods: This health–economic evaluation alongside a randomized controlled trial included 155 patients with a psychotic disorder in care as usual (CAU), with comorbid PTSD. Participants received eye movement desensitization and reprocessing (EMDR) (n = 55), prolonged exposure (PE) (n = 53) or waiting list (WL) (n = 47) with masked assessments at baseline (T0) and at the two-month (post-treatment, T2) and six-month follow-up (T6). Costs were calculated using the TiC-P interview for assessing healthcare consumption and productivity losses. Incremental cost-effectiveness ratios and economic acceptability were calculated for quality-adjusted life years (EQ-5D-3L-based QALYs) and PTSD ‘Loss of diagnosis’ (LoD, CAPS).

Results: Compared to WL, costs were lower in EMDR (-€1410) and PE (-€501) per patient per six months. In addition, EMDR (robust SE 0.024, t = 2.14, p = .035) and PE (robust SE 0.024, t = 2.14, p = .035) yielded a 0.052 and 0.051 incremental QALY gain, respectively, as well as 26% greater probability for LoD following EMDR (robust SE = 0.096, z = 2.66, p = .008) and 22% following PE (robust SE 0.098, z = 2.28, p = .023). Acceptability curves indicate high probabilities of PTSD treatments being the better economic choice. Sensitivity analyses corroborated these outcomes.

Conclusion: Adding PTSD treatment to CAU for individuals with psychosis and PTSD seem to yield better health and less PTSD at lower costs, which argues for implementation.

• This is the first randomized study (N = 155) to examine cost-effectiveness of trauma focused therapy (TFT) in psychotic patients.• Exposure and EMDR yielded less PTSD, better health and lower costs than a PTSD waiting list.• TFT in psychosis is a candidate for clinical guidelines.

Funding

This work was supported by the Dutch Support Foundation ‘Stichting tot Steun VCVGZ’, PO Box 9219, 6800 HZ Arnhem, the Netherlands: tel. +31(26) 3898900, E-mail: info@stichtingtotsteunVCVGZ.nl. Funding was awarded to Dr. van der Gaag. The funder of the study had no role in the study design, data collection, data analysis, data interpretation or writing of the report.

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