Health–economic Benefits of Treating Trauma in Psychosis

de Bont, P.A.J.M. ORCID: https://orcid.org/0000-0002-4755-5711, van der Vleugel, B.M., van den Berg, D.P.G. ORCID: https://orcid.org/0000-0002-8797-8217, de Roos, C. ORCID: https://orcid.org/0000-0001-8792-617X, Lokkerbol, J. ORCID: https://orcid.org/0000-0001-9949-5442, Smit, F., de Jongh, Ad ORCID: https://orcid.org/0000-0001-6031-9708, van der Gaag, M. ORCID: https://orcid.org/0000-0002-3525-6415 and van Minnen, A. ORCID: https://orcid.org/0000-0002-3099-8444 (2019) Health–economic Benefits of Treating Trauma in Psychosis. European Journal of Psychotraumatology, 10 (1). p. 1565032. ISSN 2000-8066

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Abstract

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.

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