Screening and Treatment of Posttraumatic Stress Disorder in Wildfire Evacuees: A Cost-Utility Analysis.

IF 1.9 Q3 HEALTH CARE SCIENCES & SERVICES MDM Policy and Practice Pub Date : 2024-06-19 eCollection Date: 2024-01-01 DOI:10.1177/23814683241260423
Michael Lebenbaum, S Ahmed Hassan
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Abstract

Background. Global climate change is resulting in dramatic increases in wildfires. Individuals exposed to wildfires experience a high burden of posttraumatic stress disorder (PTSD), and the cost-effectiveness of the treatment options to address PTSD from wildfires has not been studied. The objective of this study was to conduct a cost-utility analysis comparing screening followed by treatment with paroxetine or trauma-focused cognitive behavioral therapy (TF-CBT) versus no screening in Canadian adult wildfire evacuees. Methods. Using a Markov model, quality-adjusted life-years (QALYs) and costs were evaluated over a 5-y time horizon using health care and societal perspectives. All costs and utilities in the model were discounted at 1.5%. Probabilistic and deterministic sensitivity analyses examined the uncertainty in the incremental net monetary benefit (INMB) under a willingness-to-pay threshold of $50,000. Results. From a societal perspective, no screening (NMB = $177,641) was dominated by screening followed by treatment with paroxetine (NMB = $180,733) and TF-CBT (NMB = $181,787), with TF-CBT having the highest likelihood of being cost-effective at a willingness-to-pay threshold of $50,000 per QALY (probability = 0.649). The initial prevalence of PTSD, probability of acceptance of treatment, and costs of productivity had the largest impact on the INMB of both paroxetine or TF-CBT versus no screening. Neither intervention was cost-effective at a willingness-to-pay threshold of $50,000 per QALY from a health care perspective. Interpretation. Screening followed by treatment with paroxetine or TF-CBT compared with no screening was found to be cost-saving while providing additional QALYs in wildfire evacuees. Governments should consider funding screening programs for PTSD followed by treatment with TF-CBT for wildfire evacuees.

Highlights: Two prior studies examined the cost-effectiveness of screening followed by treatment for PTSD among individuals exposed to other disaster-type events (i.e., terrorist attack and Hurricane Sandy) and found screening followed by treatment (i.e., cognitive behavioral therapy [CBT]) to be highly cost-effective.Among wildfire evacuees, screening followed by treatment with paroxetine or trauma-focused (TF)-CBT provides additional quality-adjusted life-years (QALYs) and is cost-saving from a societal perspective. TF-CBT was the treatment option found most likely to be cost-effective.Neither treatment option was cost-effective at a willingness-to-pay threshold of $50,000 per QALY from a health care perspective.Screening programs for PTSD should be considered for wildfire evacuees, and individuals diagnosed with PTSD could be prescribed either TF-CBT or paroxetine depending on their preference and resources availability.

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野火疏散人员创伤后应激障碍的筛查和治疗:成本效用分析》。
背景。全球气候变化导致野火急剧增加。暴露在野火中的人患创伤后应激障碍(PTSD)的几率很高,而针对野火引起的创伤后应激障碍的治疗方案的成本效益尚未得到研究。本研究旨在对加拿大成年野火疏散人员进行成本效用分析,比较筛查后使用帕罗西汀或创伤认知行为疗法(TF-CBT)治疗与不进行筛查的区别。研究方法采用马尔可夫模型,从医疗保健和社会角度评估了 5 年时间跨度内的质量调整生命年 (QALY) 和成本。模型中所有成本和效用的贴现率均为 1.5%。概率和确定性敏感性分析考察了在 50,000 美元的支付意愿阈值下增量净货币效益 (INMB) 的不确定性。结果。从社会角度来看,不进行筛查(净货币效益=177,641 美元)和使用帕罗西汀治疗(净货币效益=180,733 美元)以及 TF-CBT 治疗(净货币效益=181,787 美元)的成本效益最高(概率=0.649),其次是帕罗西汀治疗(净货币效益=180,733 美元)和 TF-CBT 治疗(净货币效益=181,787 美元)。帕罗西汀或 TF-CBT 与不进行筛查相比,创伤后应激障碍的初始患病率、接受治疗的概率以及生产成本对 INMB 的影响最大。从医疗保健的角度来看,在每 QALY 50,000 美元的支付意愿阈值下,两种干预方法都不具有成本效益。解释:筛查后使用帕罗西汀治疗。与不进行筛查相比,筛查后使用帕罗西汀或TF-CBT治疗可节省成本,同时还能为野火疏散人员提供额外的QALY。各国政府应考虑资助创伤后应激障碍筛查项目,然后为野火疏散人员提供TF-CBT治疗:在野火疏散人员中,筛查后使用帕罗西汀或以创伤为中心的 CBT 治疗可提供额外的质量调整生命年(QALYs),从社会角度看可节约成本。TF-CBT是最有可能实现成本效益的治疗方案。从医疗保健的角度来看,在每质量调整生命年50,000美元的支付意愿阈值下,两种治疗方案都不具有成本效益。应考虑为野火疏散人员开展创伤后应激障碍筛查项目,被诊断为创伤后应激障碍的患者可根据其偏好和资源可用性,选择TF-CBT或帕罗西汀。
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来源期刊
MDM Policy and Practice
MDM Policy and Practice Medicine-Health Policy
CiteScore
2.50
自引率
0.00%
发文量
28
审稿时长
15 weeks
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