Comparison of Simulated Treatment and Cost-effectiveness of a Stepped Care Case-Finding Intervention vs Usual Care for Posttraumatic Stress Disorder After a Natural Disaster

Cohen, Gregory H.; Tamrakar, Shailesh; Lowe, Sarah R.; Sampson, Laura; Ettman, Catherine K.; Linas, B.P.; Ruggiero, Kenneth J.; Galea, Sandro

doi:10.1001/jamapsychiatry.2017.3037

Cited by 35 publications

(48 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The earliest EE was published in 1997 (Fontana & Rosenheck, 1997 ) and the most recent EE was published in 2019 (Aas et al, 2019 ) ( Table 1 ). Ten studies were conducted in the USA (Cohen et al, 2017 ; Domino et al, 2005 ; Fontana & Rosenheck, 1997 ; Gilbert, 2009 ; Greer et al, 2014 ; Le et al, 2014 ; Morland et al, 2013 ; Painter et al, 2017 ; Slade et al, 2017 ; Wood et al, 2009 ), three in Australia (Gospodarevskaya & Segal, 2012 ; Issakidis et al, 2004 ; Mihalopoulos et al, 2015 ) and five in Europe (Aas et al, 2019 ; Chang et al, 2018 ; Macdonald et al, 2016 ; McCrone et al, 2005 ; Shearer et al, 2018 ). The sample size of the studies ranged from N = 29 (Shearer et al, 2018 ) to N = 2,006 (Domino et al, 2005 ) in trial-based EEs.…”

Section: Resultsmentioning

confidence: 99%

Economic evaluations and cost analyses in posttraumatic stress disorder: a systematic review

Warth

Dams

Grochtdreis

et al. 2020

European Journal of Psychotraumatology

View full text Add to dashboard Cite

Background Posttraumatic stress disorder is associated with a high economic burden. Costs of treatment are known to be high, and cost-effectiveness has been analysed for several treatment options. Objective As no review on economic aspects of posttraumatic stress disorder exists, the aim of this study was to systematically review costs-of-illness studies and economic evaluations of therapeutic treatment for posttraumatic stress disorder, and to assess their quality. Method A systematic literature search was performed in March 2017 and was last updated in February 2020 in the databases PubMed, PsychInfo and NHS Economic Evaluation Database. Cost-of-illness studies and economic evaluations of treatment for posttraumatic stress disorder were selected. Extracted cost data were categorized as direct costs and indirect costs and inflated to 2015 US-$ purchasing power parities (PPP). Quality was assessed using an adapted cost-of-illness studies quality checklist, the Consensus on Health Economic Criteria list, and the questionnaire to assess relevance and credibility of modelling studies by the International Society for Pharmacoeconomics and Outcome Research. Results In total, 13 cost-of-illness studies and 18 economic evaluations were included in the review. Annual direct excess costs ranged from 512 US-$ PPP to 19,435 US-$ PPP and annual indirect excess costs were 5,021 US-$ PPP per person. Trauma-focused cognitive-behavioural therapy (+selective serotonin re-uptake inhibitor) was found to be cost-effective compared with treatment as usual and no treatment. Overall, included studies were of low and moderate quality. Studies used inappropriate economic study designs and lacked information on the economic perspective used. Conclusions Posttraumatic stress disorder is a major public health problem that causes high healthcare costs. While trauma-focused cognitive-behavioural therapy was found to be cost-effective, further investigations regarding pharmacotherapy and other treatments are necessary.

show abstract

Section: Resultsmentioning

confidence: 99%

Economic evaluations and cost analyses in posttraumatic stress disorder: a systematic review

Warth

Dams

Grochtdreis

et al. 2020

European Journal of Psychotraumatology

View full text Add to dashboard Cite

show abstract

“…Clinical interventions delivered by trained professionals are required for only a small proportion of disaster-affected populations, while most survivors would benefit from a range of lower intensity interventions that can help reduce distress [14]. Services would then ideally be delivered in a steppedcare approach often used in disaster mental health to support different levels of interventions depending on the timing of the disaster and level of distress [10,34].…”

Section: Mental Health Services To Address Climate Change Impactsmentioning

confidence: 99%

“…Skills for Psychological Recovery (SPR) is another indicated stepped approach designed for treatment of postdisaster mental health problems and is consistent with empirically supported principles following disaster [50]. Although it has been demonstrated to be acceptable to clinicians [34] and cost-effective in simulated agent-based models, its effectiveness has yet to be evaluated using randomized controlled trials. Unfortunately, the evidence supporting the use of these interventions in both short-term and long-term disaster recovery and addressing the psychosocial impacts of other manifestations of climate change is limited, especially in low resource settings with few trained clinicians and mental health facilities [10].…”

Section: Mental Health Services For Acute Eventsmentioning

confidence: 99%

Strategies for Delivering Mental Health Services in Response to Global Climate Change

Palinkas¹,

O’Donnell²,

Lau³

et al. 2020

Preprint

View full text Add to dashboard Cite

This review examines from a services perspective strategies for preparedness and response to mental health impacts of three types of climate-related events: 1) acute climate-related events such as hurricanes, floods and wildfires, 2) sub-acute or long-term changes in the environment such as drought and heat stress; and 3) the existential threat of long-lasting changes, including higher temperatures, rising sea levels and a permanently altered and potentially uninhabitable physical environment. Strategies for acute events include development and implementation of guidelines and interventions for monitoring and treating adverse mental health outcomes and strengthening individual and community resilience, training of non-mental health professionals for services delivery, and the mapping of available resources and locations of at-risk populations. Additional strategies for sub-acute changes include advocacy for mitigation policies and programs and adaptation of guidelines and interventions to address the secondary impacts of sub-acute events such as economic loss, threats to livelihood, health and well-being, population and family displacement, environmental degradation and collective violence. Strategies for long-lasting changes include implementation of evidence-based risk communication interventions that address the existential threat of climate change, promoting the mental health benefits of environmental conservation, and promoting positive mental health impacts of climate change.

show abstract

“…Third, the PAO predicts—and aims to inspire—new emphases and approaches to PTS(D) management and prevention, including allostatic interventional strategies described in Section “Implications of the Two Paradigms for Intervention on the Brain.” Given the complexities alluded to in PTS(D) ontology, pathogenesis, and comorbidity, it is unsurprising that there is no consensus regarding what to do about PTS(D) on a population basis, whether it can be prevented and if so then how, and whether efforts toward such challenges are worth the resources they might require. Though studies have been conducted on these questions (e.g., Cohen et al, 2017), it seems that the assumptions and data which would inform any “evidence-based” modeling of a moonshot to prevent and eliminate the negative effects of stress , for example, are likely to be unacceptably fragile or absent. Not only is the homeostatic evidence for subtle yet chronic stress effects inadequate for the kinds of conceptualizations entailed by the PAO, also the scientific appreciation for neural complexity is still only elementary (including the girders or limits of free will), and there is a need for advanced allostatic interventional strategy.…”

Section: Selected Considerations and Summarymentioning

confidence: 99%

A Copernican Approach to Brain Advancement: The Paradigm of Allostatic Orchestration

Lee

2019

Front. Hum. Neurosci.

View full text Add to dashboard Cite

There are two main paradigms for brain-related science, with different implications for brain-focused intervention or advancement. The paradigm of homeostasis (“stability through constancy,” Walter Cannon), originating from laboratory-based experimental physiology pioneered by Claude Bernard, shows that living systems tend to maintain system functionality in the direction of constancy (or similitude). The aim of physiology is to elucidate the factors that maintain homeostasis, and therapeutics aim to correct abnormal factor functions. The homeostasis paradigm does not formally recognize influences outside its controlled experimental frames and it is variable in its modeling of neural contributions. The paradigm of allostatic orchestration (PAO) extends the principle of allostasis (“stability through change”) as originally put forth by Peter Sterling. The PAO originates from an evolutionary perspective and recognizes that biological set points change in anticipation of changing environments . The brain is the organ of central command, orchestrating cross-system operations to support optimal behavior at the level of the whole organism. Alternative views of blood pressure regulation and posttraumatic stress disorder (PTSD) illustrate differences between the paradigms. For the PAO, complexities of top-down neural effects and environmental context are foundational (not to be “factored out”), and anticipatory regulation is the principle of their interface. The allostatic state represents the integrated totality of brain-body interactions. Health itself is an allostatic state of optimal anticipatory oscillation , hypothesized to relate to the state of criticality, a mathematical point of poise between phases, on the border between order and disorder (or the “edge of chaos”). Diseases are allostatic states of impaired anticipatory oscillations, demonstrated as rigidifications of set points across the brain and body (disease comorbidity). Conciliation of the paradigms is possible, with “reactive homeostasis” resolved as an illusion stemming from the anticipation of environmental monotony. Considerations are presented with respect to implications of the two paradigms for brain-focused intervention or advancement; the hypothesis that the state of criticality is a vehicle for evolutionary processes; concordance with a philosophy of freedom based on ethical individualism as well as self-creativity, non-obsolescence, empowerment, and citizenship; and concluding reflections on the science and ethics of the placebo, and the potential for virtuous cycles of brain-Anthropocene interactions.

show abstract

Comparison of Simulated Treatment and Cost-effectiveness of a Stepped Care Case-Finding Intervention vs Usual Care for Posttraumatic Stress Disorder After a Natural Disaster

Cited by 35 publications

References 40 publications

Economic evaluations and cost analyses in posttraumatic stress disorder: a systematic review

Economic evaluations and cost analyses in posttraumatic stress disorder: a systematic review

Strategies for Delivering Mental Health Services in Response to Global Climate Change

A Copernican Approach to Brain Advancement: The Paradigm of Allostatic Orchestration

Contact Info

Product

Resources

About