Cost effectiveness of interventions for Post-Traumatic Stress Disorders following major incidents including terrorism and pandemics

Davies, M.; Hogan, N.; Knapp, M.; McDaid, D.; Brewin, C.

Background Post-traumatic stress disorder (PTSD) is commonly experienced in the aftermath of major incidents such as terrorism and pandemics. Well-established principles of response include effective and scalable treatment for individuals affected by PTSD. In England, such responses have combined proactive outreach, screening, and evidence-based interventions (a 'screen-and-treat' approach), but little is known about the cost-effectiveness of this approach. Methods A decision modelling analysis was undertaken to estimate the costs per quality adjusted life year (QALY) gained from a screen-and-treat approach compared to treatment-as-usual. Model input variables were drawn from relevant empirical studies in the context of terrorism and the unit costs of health and social care in England. The model was run over a five-year time horizon for a hypothetical cohort of 1,000 exposed adults from the perspective of the National Health Service and Personal Social Services in England. Results The incremental cost per QALY gained was GBP8,297. This would be considered cost-effective 95% of the time at a willingness-to-pay threshold of GBP20,000 per QALY gained, the threshold associated with NICE. Sensitivity analysis confirmed this result was robust. Conclusions A screen-and-treat approach for identifying and treating PTSD in adults following major incidents appears cost-effective in England compared to treatment-as-usual through conventional primary care routes. This finding was in the context of terrorism but can be translatable into other major-incident related scenarios including the current COVID-19 pandemic in lieu of data on the impact of this pandemic.