Abstract:
Background: 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 (TFCBT) over non-directive counselling as a more efficacious treatment.
Methods: 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.
Results: 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 nondirective 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.
Conclusion: 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