Cost‐effectiveness of cognitive therapy as an early intervention for post‐traumatic stress disorder in children and adolescents: a trial based evaluation and model

Abstract

Background: Untreated post-traumatic stress disorder (PTSD) in children and adolescents is associated with a considerable economic burden on the health system, families and society. Recent research has demonstrated the potential efficacy of cognitive therapy as an early intervention for PTSD in children and adolescents. Children who experienced a single traumatic event in the previous two to six months and were randomized to cognitive therapy for PTSD (CT-PTSD) were significantly more likely to be PTSD-free compared to those randomized to usual care represented by waitlist control. The current study evaluated the economic impact of improvements in the treatment of PTSD in children and adolescents. Methods: A cost-effectiveness analysis was conducted from the national health service/personal social services perspective with outcomes expressed as quality-adjusted life years (QALYs). Patient level costs and outcomes were collected during the 11 week clinical trial and extrapolated to a three year time horizon using economic modelling methods. Uncertainty was estimated using probabilistic sensitivity analysis and assumptions were tested using one way sensitivity analysis. Results: The incremental cost-effectiveness ratio at 3 years was £2,205 per QALY with a 60%-69% probability of CT-PTSD being cost-effective compared to usual care at the UK £20,000 to £30,000 per QALY decision threshold. Conclusions: This study provides preliminary evidence for the cost-effectiveness of cognitive therapy in this treatment population. Larger pragmatic trials with longer follow-up are indicated.

Cost‐effectiveness of psychological interventions for children and young people with post‐traumatic stress disorder

“…Our findings are in agreement with previous economic evidence, which suggests that TF‐CBT, either individual or group, is more cost‐effective than waitlist (Shearer et al, ), treatment as usual (Aas et al, ; Mihalopoulos et al, ) or counselling (Gospodarevskaya & Segal, ). Our economic analysis estimated the cost‐effectiveness of a wider range of psychological interventions available for youth with PTSD, such as different forms of TF‐CBT, EMDR, parent training, family therapy, play therapy and supportive counselling and allowed, for the first time, simultaneous comparisons of cost‐effectiveness across interventions, and their ranking from the most to the least cost‐effective.…”

“…A secondary economic analysis was conducted that used utility data from children and young people aged 8–17 years with PTSD who participated in a RCT of cognitive therapy for PTSD 2–6 months after single trauma (Shearer et al, ). HRQoL was rated using the parent‐completed Strengths and Difficulties Questionnaire, and subsequently mapped onto the Child Health Utility Index 9D using a published algorithm (Furber, Segal, Leach, & Cocks, ).…”

“…Costs associated with the PTSD and no‐PTSD health states were taken from the study by Shearer et al (). NHS/PSS costs including staff time (general practitioner, nurse, paediatrician, clinical psychologist, etc.…”

“…A number of psychological interventions have been shown to be effective in the treatment of PTSD in youth, predominantly trauma‐focused cognitive behavioural therapy (TF‐CBT) and, to a lesser extent, eye movement desensitisation and reprocessing (EMDR) (Mavranezouli et al, ). Published economic evaluations in this field have concluded that cognitive therapy for PTSD, an individual form of TF‐CBT (Shearer et al, ), individual TF‐CBT (Mihalopoulos et al, ) and group TF‐CBT (Aas, Iversen, Holt, Ormhaug, & Jensen, ) were more cost‐effective than waitlist or treatment as usual; TF‐CBT was also found to be more cost‐effective than counselling (Gospodarevskaya & Segal, ) whereas group psychotherapy was likely more cost‐effective than individual psychotherapy (McCrone et al, ). These economic studies evaluated a limited range of interventions available for the treatment of PTSD in youth and made very few comparisons between active interventions.…”

A decennial review of psychotraumatology: what did we learn and where are we going?

“…We now also know these are not only effective in the short-term, but also in the long-term (see Kline, Cooper, Rytwinski, & Feeny, 2018). We also have evidence from health economic studies that these treatments are costeffective (De Bont et al, 2019;Shearer et al, 2018). On the basis of comprehensive meta-analyses, recent national and international clinical guidelines have recommended several trauma-focused cognitive behavioural treatment programmes and EMDR as first-line treatments for PTSD (APA, 2017; International Society for Traumatic Stress Studies, 2019; National Institute of Health and Care Excellence, 2018).…”