Small cost for big improvements in PTSD treatment
Deakin health economists have found that many people with PTSD are not receiving appropriate treatment.
About one third of Australians seeking treatment for Post-Traumatic Stress Disorder (PTSD) are not getting appropriate treatment, according to two of the nation’s most respected health economists, based at Deakin University.
Yet for a relatively low cost, the provision of adequate treatment to adults and children with PTSD would have huge benefits for individuals, their families and the wider community.
The research has been published in Australia 21’s “Trauma-related stress in Australia: Essays by leading thinkers and researchers.”
It was undertaken by Anne Magnus, a health economist within Deakin’s Centre for Population Health Research, and Cathrine Mihalopoulos, an Associate Professor of Mental Health Economics, who leads Australia’s first research group dedicated to the economics of mental health, within Deakin Health Economics.
The two claim that the scale of the problem of inadequate treatment or no treatment is immense and touches the lives of many thousands of Australians, with the condition generating massive costs in mental health care, drug and alcohol use, family disruption and lost productivity.
In fact, they estimate that around 824,000 Australians aged 15-85 would have a diagnosis of PTSD in 2015. Of that number, only about 367,000 sought help for their mental health and, of those who did, about one-third, or 121,000, did not receive effective care.
In their project, “Cost-benefit analyses of treatments recommended in Australian clinical practice guidelines,” the researchers assessed the cost-effectiveness, affordability and acceptability of the new Australian clinical guidelines on PTSD, developed in 2013. Their findings provide economic evidence for the benefits of adopting the evidence-based, recommended treatments within the guidelines.
Ms Magnus explained that of the many different types of therapy available, the evidence is clear. Trauma-focussed cognitive-behavioural therapy (TF-CBT) is the most effective.
“If an adult receives Trauma-focussed cognitive- behavioural therapy (TF-CBT), their risk of having PTSD after treatment is halved. If a child receives it, their risk of having PTSD after treatment is only 14 per cent,” she said.
“However, TF-CBT is confronting and it can be hard for patients to find practitioners who can deliver the treatment skilfully. People need to be exposed gradually and carefully to their traumatic memory, so they can process the experience and become desensitised.”
The researchers also assessed the cost of using selective serotonin reuptake inhibitors (SSRIs), which are the recommended anti-depressant drug treatment for adults with PTSD who are expected to respond well to a prescribed medication. They found that the benefits of using this drug far outweigh the small extra cost for a majority of patients with this condition, who are currently prescribed a medication other than this type of antidepressant (SSRIs).
“There is wide variation in the effectiveness of SSRIs, with some adults responding better than others, but the cost is worth it. We found an 87 per cent chance of health gain, which means that, for only $200, there is a year of health gain,” said Ms Magnus.
“If society was to ask “where is our health dollar going?” this would be a ‘no brainer,’ when you consider the benefits and the costs of so many treatments for other medical conditions.”
Enabling the public to benefit from these findings will require a concerted effort from organisations such as the Australian Centre of Post Traumatic Mental Health, which funded the research, and other mental health advocates and policy makers.
“It will require upskilling therapists and supervisors so they can provide appropriate Trauma focussed CBT, and encouraging therapists and patients to overcome their reluctance to take this option,” Ms Magnus said.
“There has been very little done to fully understand the cost of PTSD in Australia. The question is worthy of a full economic study. Some estimates have been made for military service personnel, motor vehicle accident victims and people who have experienced domestic violence, but more could be done, with a consistent approach that captures a broad range of impacts.“At a minimum, estimates should include health service utilisation, productivity losses from
“At a minimum, estimates should include health service utilisation, productivity losses from impact on work or study, quality of life, suicidal behaviours, association with harmful, risk-taking behaviour, such as smoking, alcohol and drug abuse, and, finally, impact on immediate family relationships.”
People wishing to discuss depression or suicide can contact “Beyond Blue” on tel: 1300 22 4636, or contact the Suicide Call Back Service at https://www.suicidecallbackservice.org.au.
• “Trauma related stress in Australia. Essays by leading Australian thinkers and researchers.” “Australia 21” and “Fearless.” September 2016.
• “Is implementation of the 2013 Australian treatment guidelines for posttraumatic stress disorder cost-effective compared to current practice? A cost-utility analysis using QALYs and DALYs.” “Australian and New Zealand Journal of Psychiatry,” August 2014.