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

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dc.contributor.author Gospodarevskaya, E., & Segal, L.
dc.date.accessioned 2013-10-02T15:04:54Z
dc.date.available 2013-10-02T15:04:54Z
dc.date.issued 2012
dc.identifier.citation 8. Gospodarevskaya, E., & Segal, L. (2012). Cost-utility analysis of different treatments for post-traumatic stress disorder in sexually abused children. Child and adolescent psychiatry and mental health, 6(1), 1-15. en_US
dc.identifier.uri http://hdl.handle.net/11212/1188
dc.identifier.uri http://www.capmh.com/content/pdf/1753-2000-6-15.pdf
dc.description.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 en_US
dc.language.iso en_US en_US
dc.publisher Child and adolescent psychiatry and mental health en_US
dc.subject traumatic stress en_US
dc.subject child sexual abuse en_US
dc.subject trauma focused cognitive behavioral therapy en_US
dc.subject Australia en_US
dc.title Cost-utility analysis of different treatments for post-traumatic stress disorder in sexually abused children. en_US
dc.type Article en_US


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