Health–economic benefits of treating trauma in psychosis

P. de Bont, Berber M. Van Der Vleugel, David van den Berg, Carlijn De Roos, Joran Lokkerbol, Filip Smit, A. de Jongh, M. van der Gaag, Agnes van Minnen

Research output: Contribution to JournalArticleAcademicpeer-review

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.
LanguageEnglish
Pages1565032
Number of pages12
JournalEuropean Journal of Psychotraumatology
Publication statusPublished - 2019

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Insurance Benefits
Post-Traumatic Stress Disorders
Psychotic Disorders
Economics
Eye Movement Desensitization Reprocessing
Wounds and Injuries
Quality-Adjusted Life Years
Cost-Benefit Analysis
Costs and Cost Analysis
Waiting Lists
Health
Guidelines
Therapeutics
Psychological Stress
Randomized Controlled Trials
Interviews
Delivery of Health Care

Keywords

  • KEA CUA Cost-effectiveness psychosis TTIP psychotic disorder QALY quality-adjusted life years PTSD EMDR prolonged exposure

VU Research Profile

  • Human Health and Life Sciences

Cite this

de Bont, P., Van Der Vleugel, B. M., van den Berg, D., De Roos, C., Lokkerbol, J., Smit, F., ... van Minnen, A. (2019). Health–economic benefits of treating trauma in psychosis. European Journal of Psychotraumatology, 1565032.
de Bont, P. ; Van Der Vleugel, Berber M. ; van den Berg, David ; De Roos, Carlijn ; Lokkerbol, Joran ; Smit, Filip ; de Jongh, A. ; van der Gaag, M. ; van Minnen, Agnes. / Health–economic benefits of treating trauma in psychosis. In: European Journal of Psychotraumatology. 2019 ; pp. 1565032.
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title = "Health–economic benefits of treating trauma in psychosis",
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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author = "{de Bont}, P. and {Van Der Vleugel}, {Berber M.} and {van den Berg}, David and {De Roos}, Carlijn and Joran Lokkerbol and Filip Smit and {de Jongh}, A. and {van der Gaag}, M. and {van Minnen}, Agnes",
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de Bont, P, Van Der Vleugel, BM, van den Berg, D, De Roos, C, Lokkerbol, J, Smit, F, de Jongh, A, van der Gaag, M & van Minnen, A 2019, 'Health–economic benefits of treating trauma in psychosis', European Journal of Psychotraumatology, pp. 1565032.

Health–economic benefits of treating trauma in psychosis. / de Bont, P.; Van Der Vleugel, Berber M.; van den Berg, David; De Roos, Carlijn; Lokkerbol, Joran; Smit, Filip; de Jongh, A.; van der Gaag, M.; van Minnen, Agnes.

In: European Journal of Psychotraumatology, 2019, p. 1565032.

Research output: Contribution to JournalArticleAcademicpeer-review

TY - JOUR

T1 - Health–economic benefits of treating trauma in psychosis

AU - de Bont, P.

AU - Van Der Vleugel, Berber M.

AU - van den Berg, David

AU - De Roos, Carlijn

AU - Lokkerbol, Joran

AU - Smit, Filip

AU - de Jongh, A.

AU - van der Gaag, M.

AU - van Minnen, Agnes

PY - 2019

Y1 - 2019

N2 - 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.

AB - 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.

KW - KEA CUA Cost-effectiveness psychosis TTIP psychotic disorder QALY quality-adjusted life years PTSD EMDR prolonged exposure

M3 - Article

SP - 1565032

JO - European Journal of Psychotraumatology

T2 - European Journal of Psychotraumatology

JF - European Journal of Psychotraumatology

SN - 2000-8066

ER -

de Bont P, Van Der Vleugel BM, van den Berg D, De Roos C, Lokkerbol J, Smit F et al. Health–economic benefits of treating trauma in psychosis. European Journal of Psychotraumatology. 2019;1565032.