Cost-utility analysis of different treatments for post-traumatic stress disorder in sexually abused children

<p>Abstract</p> <p>Background</p> <p>Post-traumatic stress disorder (PTSD) is diagnosed in 20% to 53% of sexually abused children and adolescents. Living with PTSD is associated with a loss of health-related quality of life. Based on the best available evidence, the NICE Guideline for PTSD in children and adolescents recommends cognitive behavioural therapy (TF-CBT) over non-directive counselling as a more efficacious treatment.</p> <p>Methods</p> <p>A modelled economic evaluation conducted from the Australian mental health care system perspective estimates incremental costs and Quality Adjusted Life Years (QALYs) of TF-CBT, TF-CBT combined with selective serotonin reuptake inhibitor (SSRI), and non-directive counselling. The "no treatment" alternative is included as a comparator. The first part of the model consists of a decision tree corresponding to 12 month follow-up outcomes observed in clinical trials. The second part consists of a 30 year Markov model representing the slow process of recovery in non-respondents and the untreated population yielding estimates of long-term quality-adjusted survival and costs. Data from the 2007 Australian Mental Health Survey was used to populate the decision analytic model.</p> <p>Results</p> <p>In the base-case and sensitivity analyses, incremental cost-effectiveness ratios (ICERs) for all three active treatment alternatives remained less than A$7,000 per QALY gained. The base-case results indicated that non-directive counselling is dominated by TF-CBT and TF-CBT + SSRI, and that efficiency gain can be achieved by allocating more resources toward these therapies. However, this result was sensitive to variation in the clinical effectiveness parameters with non-directive counselling dominating TF-CBT and TF-CBT + SSRI under certain assumptions. The base-case results also suggest that TF-CBT + SSRI is more cost-effective than TF-CBT.</p> <p>Conclusion</p> <p>Even after accounting for uncertainty in parameter estimates, the results of the modelled economic evaluation demonstrated that all psychotherapy treatments for PTSD in sexually abused children have a favourable ICER relative to no treatment. The results also highlighted the loss of quality of life in children who do not receive any psychotherapy. Results of the base-case analysis suggest that TF-CBT + SSRI is more cost-effective than TF-CBT alone, however, considering the uncertainty associated with prescribing SSRIs to children and adolescents, clinicians and parents may exercise some caution in choosing this treatment alternative.</p

AIDS-Related Issues. Background Paper #6

This Background Paper examines the evidence of the effectiveness of drug abuse treatment; it also evaluates the role that such treatment might play in reducing the spread of HIV. Because most intravenous drug users are not in treatment, the paper also examines other approaches to HIV prevention among this high-risk group

National age and sex differences in quitting smoking.

The 1986 Adult Use of Tobacco Survey conducted by the Office on Smoking and Health of the Centers for Disease Control asked detailed questions on smoking behavior from a representative sample of 13,031 Americans. Using a smoking continuum developed from that survey as an index, it was postulated that a hard-core group of smokers would be overrepresented in some categories of this continuum in certain groups of the population. In this survey, more women than men who had quit in the preceding year had relapsed to smoking by the time of the survey. However, the fact that similar proportions of men and women had quit smoking for between one and five years suggested that the difference might not have involved the proportion who relapsed but only the timing of that relapse. Smokers over the age of 65 are more likely both to attempt to quit and to continue abstaining than those between ages 25 and 64. Results from this survey do not indicate a major group of smokers who either resist change or who feel unable to quit successfully

National age and sex differences in quitting smoking.

The 1986 Adult Use of Tobacco Survey conducted by the Office on Smoking and Health of the Centers for Disease Control asked detailed questions on smoking behavior from a representative sample of 13,031 Americans. Using a smoking continuum developed from that survey as an index, it was postulated that a hard-core group of smokers would be overrepresented in some categories of this continuum in certain groups of the population. In this survey, more women than men who had quit in the preceding year had relapsed to smoking by the time of the survey. However, the fact that similar proportions of men and women had quit smoking for between one and five years suggested that the difference might not have involved the proportion who relapsed but only the timing of that relapse. Smokers over the age of 65 are more likely both to attempt to quit and to continue abstaining than those between ages 25 and 64. Results from this survey do not indicate a major group of smokers who either resist change or who feel unable to quit successfully

Health promotion and disease prevention as a complement to community health indicators. Working group 1.

The aim of Working Group 1 has been to assess health promotion and disease prevention activities in terms of benefits, risks, and economic, social, and ethical implications as a complement to community health indicators