de Bont Paul A J M, van der Vleugel Berber M, van den Berg David P G, de Roos Carlijn, Lokkerbol Joran, Smit Filip, de Jongh Ad, van der Gaag Mark, van Minnen Agnes
Flexible Assertive Community Treatment, Mental Health Organization (MHO) GGZ Oost Brabant Land van Cuijk en Noord Limburg, Boxmeer, The Netherlands.
Behavioural Science Institute, Radboud University Nijmegen, NijCare, Nijmegen, The Netherlands.
Eur J Psychotraumatol. 2019 Jan 21;10(1):1565032. doi: 10.1080/20008198.2018.1565032. eCollection 2019.
: 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. : 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) ( = 55), prolonged exposure (PE) ( = 53) or waiting list (WL) ( = 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). : Compared to WL, costs were lower in EMDR (-€1410) and PE (-€501) per patient per six months. In addition, EMDR (robust SE 0.024, = 2.14, = .035) and PE (robust SE 0.024, = 2.14, = .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, = 2.66, = .008) and 22% following PE (robust SE 0.098, = 2.28, = .023). Acceptability curves indicate high probabilities of PTSD treatments being the better economic choice. Sensitivity analyses corroborated these outcomes. : 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.
精神病患者中创伤后应激障碍（PTSD）的共病率（估计为12%）增加了个人痛苦和社会成本。尚未对诊断为精神障碍的患者进行PTSD治疗的卫生经济学研究，但制定和实施指南需要此类研究。本研究旨在分析针对精神障碍患者的指南PTSD疗法的成本效益。 这项卫生经济学评估与一项随机对照试验一起，纳入了155名患有精神障碍且伴有共病PTSD的常规护理（CAU）患者。参与者接受了眼动脱敏再处理（EMDR）（n = 55）、延长暴露疗法（PE）（n = 53）或等待名单（WL）（n = 47），并在基线（T0）、两个月（治疗后，T2）和六个月随访（T6）时进行了盲法评估。使用TiC-P访谈计算成本，以评估医疗保健消耗和生产力损失。计算了质量调整生命年（基于EQ-5D-3L的QALYs）和PTSD“诊断丧失”（LoD，CAPS）的增量成本效益比和经济可接受性。 与WL相比，EMDR（每位患者每六个月-1410欧元）和PE（每位患者每六个月-501欧元）的成本更低。此外，EMDR（稳健标准误0.024，z = 2.14，p = 0.035）和PE（稳健标准误0.024，z = 2.14，p = 0.035）分别产生了0.052和0.051的增量QALY增益，以及EMDR后LoD概率提高26%（稳健标准误 = 0.096，z = 2.66，p = 0.008）和PE后提高22%（稳健标准误0.098，z = 2.28，p = 0.023）。可接受性曲线表明PTSD治疗很有可能是更好的经济选择。敏感性分析证实了这些结果。 对于患有精神病和PTSD的个体，在CAU基础上增加PTSD治疗似乎能以更低的成本带来更好的健康状况和更少的PTSD，这支持了实施该治疗。
