학술논문
Cost-effectiveness of therapist-assisted internet-delivered psychological therapies for PTSD differing in trauma focus in England: an economic evaluation based on the STOP-PTSD trial.
Document Type
Academic Journal
Author
Penington E; Department of Psychiatry, University of Oxford, Oxford, UK.; Wild J; Department of Experimental Psychology, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK; Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, NSW, Australia.; Warnock-Parkes E; Department of Experimental Psychology, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK; Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Kings' College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK.; Grey N; Sussex Partnership NHS Foundation Trust, Worthing, UK; School of Psychology, University of Sussex, Brighton, UK.; Murray H; Department of Experimental Psychology, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK.; Kerr A; Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Kings' College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK.; Stott R; Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Kings' College London, London, UK.; Rozental A; Department of Psychology, Uppsala University, Uppsala, Sweden; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.; Andersson G; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Behavioural Sciences and Learning and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.; Clark DM; Department of Experimental Psychology, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK.; Tsiachristas A; Department of Psychiatry, University of Oxford, Oxford, UK; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. Electronic address: apostolos.tsiachristas@psych.ox.ac.uk.; Ehlers A; Department of Experimental Psychology, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK.
Source
Publisher: Elsevier Country of Publication: England NLM ID: 101638123 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2215-0374 (Electronic) Linking ISSN: 22150366 NLM ISO Abbreviation: Lancet Psychiatry Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Although there are effective psychological treatments for post-traumatic stress disorder (PTSD), they remain inaccessible for many people. Digitally enabled therapy is a way to overcome this problem; however, there is little evidence on which forms of these therapies are most cost effective in PTSD. We aimed to assess the cost-effectiveness of the STOP-PTSD trial, which evaluated two therapist-assisted, internet-delivered cognitive behavioural therapies: cognitive therapy for PTSD (iCT-PTSD) and a programme focusing on stress management (iStress-PTSD).
Methods: In this health economic evaluation, we used data from the STOP-PTSD trial (n=217), a single-blind, randomised controlled trial, to compare iCT-PTSD and iStress-PTSD in terms of resource use and health outcomes. In the trial, participants (aged ≥18 years) who met DSM-5 criteria for PTSD were recruited from primary care therapy services in South East England. The interventions were delivered online with therapist support for the first 12 weeks, and three telephone calls over the next 3 months. Participants completed questionnaires on symptoms, wellbeing, quality of life, and resource use at baseline, 13 weeks, 26 weeks, and 39 weeks after randomisation. We used a cost-effectiveness analysis to assess cost per quality-adjusted life year (QALY) at 39 weeks post-randomisation, from the perspective of the English National Health Service (NHS) and personal social services and on the basis of intention-to-treat for complete cases. Treatment modules and the platform design were developed with extensive input from service users: service users also advised on the trial protocol and methods, including the health economic measures. This is a pre-planned analysis of the STOP-PTSD trial; the trial was registered prospectively on the ISRCTN Registry (ISRCTN16806208).
Findings: NHS costs were similar across treatment groups, but clinical outcomes were superior for iCT-PTSD compared with iStress-PTSD. The incremental cost-effectiveness ratio for NHS costs and personal social services was estimated as £1921 per QALY. iCT-PTSD had an estimated 91·6% chance of being cost effective at the £20 000 per QALY threshold. From the societal perspective, iCT-PTSD was cost saving compared with iStress-PTSD.
Interpretation: iCT-PTSD is a cost-effective form of therapist-assisted, internet-delivered psychological therapy relative to iStress-PTSD, and it could be considered for clinical implementation.
Funding: Wellcome Trust and National Institute of Health Research Oxford Health Biomedical Research Centre.
Competing Interests: Declaration of interests Face-to-face CT-PTSD and iCT-PTSD were developed by AE and DMC's team. AE, NG, JW, EW-P, HM, and DMC have occasionally given paid workshops on CT-PTSD. iStress was developed by GA's team. All other authors declare no competing interests.
(Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)
Methods: In this health economic evaluation, we used data from the STOP-PTSD trial (n=217), a single-blind, randomised controlled trial, to compare iCT-PTSD and iStress-PTSD in terms of resource use and health outcomes. In the trial, participants (aged ≥18 years) who met DSM-5 criteria for PTSD were recruited from primary care therapy services in South East England. The interventions were delivered online with therapist support for the first 12 weeks, and three telephone calls over the next 3 months. Participants completed questionnaires on symptoms, wellbeing, quality of life, and resource use at baseline, 13 weeks, 26 weeks, and 39 weeks after randomisation. We used a cost-effectiveness analysis to assess cost per quality-adjusted life year (QALY) at 39 weeks post-randomisation, from the perspective of the English National Health Service (NHS) and personal social services and on the basis of intention-to-treat for complete cases. Treatment modules and the platform design were developed with extensive input from service users: service users also advised on the trial protocol and methods, including the health economic measures. This is a pre-planned analysis of the STOP-PTSD trial; the trial was registered prospectively on the ISRCTN Registry (ISRCTN16806208).
Findings: NHS costs were similar across treatment groups, but clinical outcomes were superior for iCT-PTSD compared with iStress-PTSD. The incremental cost-effectiveness ratio for NHS costs and personal social services was estimated as £1921 per QALY. iCT-PTSD had an estimated 91·6% chance of being cost effective at the £20 000 per QALY threshold. From the societal perspective, iCT-PTSD was cost saving compared with iStress-PTSD.
Interpretation: iCT-PTSD is a cost-effective form of therapist-assisted, internet-delivered psychological therapy relative to iStress-PTSD, and it could be considered for clinical implementation.
Funding: Wellcome Trust and National Institute of Health Research Oxford Health Biomedical Research Centre.
Competing Interests: Declaration of interests Face-to-face CT-PTSD and iCT-PTSD were developed by AE and DMC's team. AE, NG, JW, EW-P, HM, and DMC have occasionally given paid workshops on CT-PTSD. iStress was developed by GA's team. All other authors declare no competing interests.
(Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)