Le Quang A, Doctor Jason N, Zoellner Lori A, Feeny Norah C
Department of Social and Administrative Sciences, Western University of Health Sciences, 309 E. Second St, Pomona, CA 91766-1854
J Clin Psychiatry. 2014 Mar;75(3):222-30. doi: 10.4088/JCP.13m08719.
Cost-effectiveness of treatment for posttraumatic stress disorder (PTSD) may depend on type of treatment (eg, pharmacotherapy vs psychotherapy) and patient choice of treatment. We examined the cost-effectiveness of treatment with prolonged exposure therapy versus pharmacotherapy with sertraline, overall treatment preference, preference for choosing prolonged exposure therapy, and preference for choosing pharmacotherapy with sertraline from the US societal perspective.
Two hundred patients aged 18 to 65 years with PTSD diagnosis based on DSM-IV criteria enrolled in a doubly randomized preference trial. Patients were randomized to receive their treatment of choice (n = 97) or to be randomly assigned treatment (n = 103). In the choice arm, patients chose either prolonged exposure therapy (n = 61) or pharmacotherapy with sertraline (n = 36). In the no-choice arm, patients were randomized to either prolonged exposure therapy (n = 48) or pharmacotherapy with sertraline (n = 55). The total costs, including direct medical costs, direct nonmedical costs, and indirect costs, were estimated in 2012 US dollars; and total quality-adjusted life-year (QALY) was assessed using the EuroQoL Questionnaire-5 dimensions (EQ-5D) instrument in a 12-month period. This study was conducted from July 2004 to January 2009.
Relative to pharmacotherapy with sertraline, prolonged exposure therapy was less costly (-$262; 95% CI, -$5,068 to $4,946) and produced more QALYs (0.056; 95% CI, 0.014 to 0.100) when treatment was assigned, with 93.2% probability of being cost-effective at $100,000/QALY. Independently, giving a choice of treatment also yielded lower cost (-$1,826; 95% CI, -$4,634 to $749) and more QALYs (0.010; 95% CI, -0.019 to 0.044) over no choice of treatment, with 87.0% probability of cost-effectiveness at $100,000/QALY.
Giving PTSD patients a choice of treatment appears to be cost-effective. When choice is not possible, prolonged exposure therapy may provide a cost-effective option over pharmacotherapy with sertraline.
ClinicalTrials.gov identifier: NCT00127673.
创伤后应激障碍（PTSD）治疗的成本效益可能取决于治疗类型（如药物治疗与心理治疗）以及患者对治疗的选择。我们从美国社会视角研究了延长暴露疗法与舍曲林药物治疗的成本效益、总体治疗偏好、选择延长暴露疗法的偏好以及选择舍曲林药物治疗的偏好。
200名年龄在18至65岁、根据《精神疾病诊断与统计手册》第四版（DSM-IV）标准诊断为PTSD的患者参加了一项双重随机偏好试验。患者被随机分配接受其选择的治疗（n = 97）或被随机分配治疗（n = 103）。在选择组中，患者选择延长暴露疗法（n = 61）或舍曲林药物治疗（n = 36）。在无选择组中，患者被随机分配接受延长暴露疗法（n = 48）或舍曲林药物治疗（n = 55）。总成本包括直接医疗成本、直接非医疗成本和间接成本，以2012年美元估算；并使用欧洲五维健康量表（EQ-5D）工具在12个月期间评估总质量调整生命年（QALY）。本研究于2004年7月至2009年1月进行。
与舍曲林药物治疗相比，当进行治疗分配时，延长暴露疗法成本更低（-262美元；95%可信区间，-5068美元至4946美元）且产生更多QALY（0.056；95%可信区间，0.014至0.100），在每QALY 100,000美元时具有成本效益的概率为93.2%。独立来看，给予治疗选择也比不给予治疗选择成本更低（-1826美元；95%可信区间，-4634美元至749美元）且产生更多QALY（0.010；95%可信区间，-0.019至0.044），在每QALY 100,000美元时具有成本效益的概率为87.0%。
给予PTSD患者治疗选择似乎具有成本效益。当无法进行选择时，与舍曲林药物治疗相比，延长暴露疗法可能提供一种具有成本效益的选择。
ClinicalTrials.gov标识符：NCT00127673。
