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PTSD Treatment Cost-Effective When Patients Given Choice

by Rodney Tanaka

May 30, 2014

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Western University of Health Sciences’ College of Pharmacy Assistant Professor Quang A. Le, PharmD, PhD, is lead author on a study showing that post-traumatic stress disorder (PTSD) patients who are allowed to choose their preferred treatment – either psychotherapy or pharmacotherapy – is a cost-effective strategy. When choice is not an option, prolonged exposure therapy, psychotherapy, is cost-effective relative to pharmacotherapy with sertraline.

The study, recently published in the Journal of Clinical Psychiatry, was co-authored by Lori Zoellner, PhD, professor and director of the University of Washington’s Center for Anxiety and Traumatic Stress; Norah Feeny, who leads the research project with Zoellner and is a professor at Case Western Reserve University in Cleveland, Ohio; and Jason Doctor, PhD, University of Southern California.

Participants were randomized to a group that was allowed to select its own treatment, or a group that had its treatment randomly assigned for them. The groups were then given 10 weeks of treatment with either the drug sertraline or psychotherapy called “prolonged exposure therapy.” Sertraline, prescribed under the names Zoloft and Lustral, is an antidepressant manufactured by Pfizer Inc., which supplied the drug for use in the study, according to a press release from the University of Washington.

PTSD patients who are allowed to choose between therapies ended up costing about $1,622 less, on average, per patient per year compared with patients whose treatments were assigned. Among patients not given a choice, treatment with prolonged exposure psychotherapy cost less than those on sertraline, according to the release.

The costs in 2012 U.S. dollars included the therapy, outpatient services, hospitalization, emergency department visits, pharmacy services and nonmedical services, as well as indirect costs such as losses in worker productivity.

“This is one of the first studies to look at the cost of providing mental health care and comparing different treatments for PTSD,” Zoellner said in the release. “It has tremendous implications for how large health care systems, such as the U.S. Department of Veterans Affairs, proceed with treating PTSD.”

The study research team used a new study design called “doubly randomized preference trial” to investigate whether giving patients a choice affects their treatment outcomes.

“Most clinical studies try to answer which treatment works best, but do not factor in how giving patients choices could affect their health,” Le said in the press release. “With this study design, we could isolate the effects of this patient choice and see if it is cost-effective.”

The clinical trial included 200 patients ages 18-65 who were diagnosed with PTSD. Data was collected from July 2004 through January 2009.

“With the doubly randomized preference trial design, we can even further answer the questions (about) whether prolonged exposure therapy is still cost-effective in the subpopulation of patients who preferred pharmacotherapy with sertraline, as well as separating the effect of treatment choice in the subpopulations of patients who received prolonged exposure therapy and in those who received pharmacotherapy with sertraline,” Le added. “It would be interesting to find out, and we will have more complete understanding of the effects of treatment choice.”

The National Institute of Mental Health funded the study, with additional funding from the American Association of Colleges of Pharmacy.

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