Purpose: To examine the cost-effectiveness of treatment effect of cognitive behavioral therapy (CBT) versus pharmacotherapy with sertraline (SER) and the overall treatment preference from the U.S. societal perspective.
Methods: Two hundred patients aged 18 to 65 years with PTSD enrolled in a doubly randomized preference trial (DRPT) examining the treatment effect and treatment-preference effects between cognitive behavioral therapy and pharmacotherapy with sertraline. Patients were randomly assigned to choice of treatment arm (n = 97) and no-choice of treatment or randomization arm (n = 103). In the choice arm, patients chose their preferred treatment either CBT (n = 61) or SER (n = 36). While in the no-choice arm, patients were randomly assigned to either CBT (n = 48) or SER (n = 55). Total costs including direct medical costs, direct non-medical costs, and indirect costs; and total quality-adjusted life years in 12-month period. All costs were adjusted to 2010 U.S. dollars. In addition to base-case analyses for the most likely scenarios, we performed one-way sensitivity analysis to test the robustness of the ICERs using the low (25th percentile) and high (75th percentile) estimates of the costs per visit for outpatient, inpatient, and ER services. The 95% confidence intervals (CIs) were estimated by using non-parametric bootstrapping method with 5,000 iterations.
Results: Relative to pharmacotherapy with sertraline, cognitive behavioral therapy was a dominant strategy (less costly but more effective). For the overall preference treatment, given choice of treatment was also a dominant strategy over no-choice of treatment. One-way sensitivity analysis with low- and high-estimates of costs produced higher cost for the CBT and lower cost for the given choice of treatment, but still resulted in dominant strategies. At the willingness-to-pay amount of $100,000/QALY, 95.3% and 87.1% probabilities that the CBT and giving patients their preferred treatments were cost-effective as compared with SER and giving patient no choice of treatments, respectively.
Conclusion: CBT and receipt of preferred treatment are more favorable than SER and receipt of non-preferred treatment, respectively.
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