Health–economic benefits of treating trauma in psychosis

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. • This is the first randomized study (N = 155) to examine cost-effectiveness of trauma focused therapy (TFT) in psychotic patients.• Exposure and EMDR yielded less PTSD, better health and lower costs than a PTSD waiting list.• TFT in psychosis is a candidate for clinical guidelines.

背景：在精神疾病（其患病率估计为12%）中与创伤后应激障碍（PTSD）的共病性加剧了个人痛苦及社会成本。针对被诊断为精神疾病的PTSD患者进行治疗的健康经济学研究尚未开展，但为制定及实施指南所必需。本研究旨在分析针对精神疾病患者的指南性PTSD疗法的成本效益。方法：本项健康经济学评估伴随一项随机对照试验，纳入了155名在接受常规护理（CAU）的同时患有共病PTSD的精神疾病患者。参与者接受了眼动脱敏与再加工（EMDR）（n = 55）、延长暴露（PE）（n = 53）或等待名单（WL）（n = 47）治疗，并在基线（T0）以及治疗后的两个月（T2）和六个月随访（T6）进行了盲法评估。成本计算采用TiC-P访谈，以评估医疗保健消费和生产率损失。计算了增量成本效益比和经济可接受性，用于质量调整生命年（基于EQ-5D-3L的QALYs）和PTSD‘诊断缺失’（LoD，CAPS）。结果：与等待名单相比，EMDR和PE的每患者每六个月成本分别降低了-€1410和-€501。此外，EMDR（稳健标准误0.024，t = 2.14，p = .035）和PE（稳健标准误0.024，t = 2.14，p = .035）分别产生了0.052和0.051的增量QALY收益，以及EMDR后26%的LoD概率增加（稳健标准误 = 0.096，z = 2.66，p = .008）和PE后22%的LoD概率增加（稳健标准误0.098，z = 2.28，p = .023）。可接受性曲线表明，PTSD治疗方案具有较高的经济选择优势。敏感性分析证实了这些结果。结论：为患有精神疾病和PTSD的个人在常规护理中加入PTSD治疗似乎能在较低的成本下带来更好的健康状况和减少PTSD，这为其实施提供了依据。•这是首个（N = 155）随机研究，旨在检验创伤聚焦疗法（TFT）在精神疾病患者中的成本效益。•暴露疗法和EMDR在减少PTSD、改善健康状况和降低成本方面优于PTSD等待名单。•精神疾病中的TFT是临床指南的潜在候选方案。