EFFECTS OF TREATMENT PREFERENCE ON HEALTH-RELATED QUALITY OF LIFE (HRQOL) OUTCOME IN POSTTRAUMATIC STRESS DISORDER (PTSD) PATIENTS

Purpose: In mental health treatment, outcomes may depend on (1) which treatment, e.g. psychotherapy or pharmacotherapy, is received, (2) whether or not choice of treatment is given, and (3) whether or not a received treatment is the preferred therapy. In the current study, we examined the effects of these key factors on the EuroQol (EQ-5D) health-utility scores in posttraumatic stress disorder (PTSD) patients.

Methods: Using the doubly randomized preference trial (DRPT) framework, we estimated the following effects on the EQ-5D health-utility scores in PTSD patients: prolonged exposure therapy (PE) vs. pharmacotherapy with sertraline (SER) in patients who preferred PE (1), as well as in those who preferred SER (2); receipt of a preferred treatment vs. receipt of an assigned treatment in patients who received PE (3), as well as in those who received SER (4); and receipt of a preferred treatment vs. receipt of non-preferred treatment in patients who received PE (5), as well as in those who received SER (6). The EQ-5D scores were measured at baseline and 10-week post-treatment and using the U.S. general population-based model.

Results: At baseline, mean EQ-5D utility scores (SD) associated with currently diagnosed PTSD were 0.630 (0.191). The effects of PE as opposed to SER on the EQ-5D scores were 0.215 (p = 0.001) and 0.031 (p = 0.736) in patients who preferred PE and in those who preferred SER, respectively. The effects of receipt of a preferred treatment as compared to receipt of an assigned treatment on the EQ-5D scores were 0.007 (p = 0.884) and 0.198 (p = 0.017) in patients who received PE and in those who received SER, respectively. The effects of receipt of a preferred treatment versus receipt of non-preferred treatment were 0.042 (p = 0.519) and 0.226 (p = 0.012) in patients who received PE and in those who received SER, respectively.

Conclusions: For PTSD treatment, PE seems to have a positive effect on HRQOL outcome in the population of patients who prefer it. Independently, giving patients an opportunity to choose a treatment rather assigning them a treatment appears to be beneficial in pharmacotherapy with sertraline. Furthermore, giving patients an opportunity to choose a treatment rather giving them a treatment that is not preferred would also be helpful in pharmacotherapy with sertraline.