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首页> 外文期刊>The journal of clinical psychiatry >Cost-effectiveness of prolonged exposure therapy versus pharmacotherapy and treatment choice in posttraumatic stress disorder (the optimizing ptsd treatment trial): A doubly randomized preference trial
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Cost-effectiveness of prolonged exposure therapy versus pharmacotherapy and treatment choice in posttraumatic stress disorder (the optimizing ptsd treatment trial): A doubly randomized preference trial

机译：创伤后应激障碍中长期暴露疗法与药物疗法及治疗选择的成本效益（ptsd优化治疗试验）：一项双重随机偏爱试验

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Objective: Cost-effectiveness of treatment for posttraumatic stress disorder (PTSD) may depend on type of treatment (eg, pharmacotherapy vs psychotherapy) and patient choice of treatment. We examined the cost-effectiveness of treatment with prolonged exposure therapy versus pharmacotherapy with sertraline, overall treatment preference, preference for choosing prolonged exposure therapy, and preference for choosing pharmacotherapy with sertraline from the US societal perspective. Method:Two hundred patients aged 18 to 65 years with PTSD diagnosis based on DSM-IVcriteria enrolled in a doubly randomized preference trial. Patients were randomized to receive their treatment of choice (n = 97) or to be randomly assigned treatment (n = 103). In the choice arm, patients chose either prolonged exposure therapy (n = 61) or pharmacotherapy with sertraline (n = 36). In the no-choice arm, patients were randomized to either prolonged exposure therapy (n =48) or pharmacotherapy with sertraline (n = 55). The total costs, including direct medical costs, direct nonmedical costs, and indirect costs, were estimated in 2012 US dollars; and total quality-adjusted life-year (QALY) was assessed using the EuroQoL Questionnaire-5 dimensions (EQ-5D) instrument in a 12-month period.This study was conducted from July 2004 to January 2009. Results: Relative to pharmacotherapy with sertraline, prolonged exposure therapy was less costly (-$262; 95% Cl, -$5,068 to 4,946) and produced more QALYs (0.056; 95% Cl, 0.014 to 0.100) when treatment was assigned, with 93.2% probability of being cost-effective at 100,000/QALY. Independently, giving a choice of treatment also yielded lower cost (-$1,826; 95% Cl, -$4,634 to749) and more QALYs (0.010; 95% Cl, -0.019 to 0.044) over no choice of treatment, with 87.0% probability of cost-effectiveness at 100,000/QALY. Conclusions: Giving PTSD patients a choice of treatment appears to be cost-effective. When choice is not possible, prolonged exposure therapy may provide a cost-effective option over pharmacotherapy with sertraline.
机译：目的：创伤后应激障碍（PTSD）的治疗成本效益可能取决于治疗类型（例如药物治疗与心理治疗）以及患者的治疗选择。我们从美国社会的角度研究了长期暴露疗法与舍曲林药物治疗的成本效益，总体治疗偏好，选择长期暴露疗法的偏好以及选择舍曲林药物治疗的偏好。方法：一项基于DSM-IV标准的PTSD诊断为18岁至65岁的200例患者参加了一项双重随机偏爱试验。患者被随机分配接受选择的治疗（n = 97）或被随机分配治疗（n = 103）。在选择方面，患者选择延长暴露治疗（n = 61）或舍曲林药物治疗（n = 36）。在非选择组，患者被随机分配到延长暴露治疗（n = 48）或舍曲林药物治疗（n = 55）。包括直接医疗费用，直接非医疗费用和间接费用在内的总费用估计为2012年美元;并在12个月内使用EuroQoL问卷5维度（EQ-5D）仪器评估了总质量调整生命年（QALY）。这项研究于2004年7月至2009年1月进行。结果：相对于药物治疗舍曲林长时间暴露疗法的成本较低（-$ 262; 95％Cl，-$ 5,068至4,946），分配治疗后产生更多的QALY（0.056; 95％Cl，0.014至0.100），具有93.2％的成本效益比100,000 / QALY。独立地，在不选择治疗的情况下，选择治疗还可以降低成本（-$ 1,826; 95％Cl，-$ 4,634至749）和更多QALY（0.010; 95％Cl，-0.019至0.044），发生成本的可能性为87.0％ -功效为100,000 / QALY。结论：给PTSD患者选择治疗似乎是划算的。当无法选择时，与舍曲林药物治疗相比，长时间暴露疗法可能是一种具有成本效益的选择。

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