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Cost-effectiveness of ‘screen-and-treat’ interventions for post-traumatic stress disorder following major incidents

Hogan, Nicole, Knapp, Martin ORCID: 0000-0003-1427-0215, McDaid, David ORCID: 0000-0003-0744-2664, Davies, Mark and Brewin, Chris R (2021) Cost-effectiveness of ‘screen-and-treat’ interventions for post-traumatic stress disorder following major incidents. BMJ Open, 11 (10). e049472. ISSN 2044-6055

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Identification Number: 10.1136/bmjopen-2021-049472


Objectives Post-traumatic stress disorder (PTSD) is commonly experienced in the aftermath of major incidents such as terrorism and pandemics. Well-established principles of response include effective and scalable treatment for individuals affected by PTSD. In England, such responses have combined proactive outreach, screening and evidence-based interventions (a ‘screenand-treat’ approach), but little is known about its costeffectiveness. The objective of this paper is to report the first systematic attempt to assess the cost-effectiveness of this approach. Methods A decision modelling analysis was undertaken to estimate the costs per quality-adjusted life-year (QALY) gained from a screen-and-treat approach compared with treatment-as-usual, the latter involving identification of PTSD by general practitioners and referral to psychological therapy services. Model input variables were drawn from relevant empirical studies in the context of terrorism and the unit costs of health and social care in England. The model was run over a 5-year time horizon for a hypothetical cohort of 1000 exposed adults from the perspective of the National Health Service and Personal Social Services in England. Results The incremental cost per QALY gained was £7931. This would be considered cost-effective 88% of the time at a willingness-to-pay threshold of £20 000 per QALY gained, the threshold associated with the National Institute for Health and Care Excellence in England. Sensitivity analysis confirmed this result was robust. Conclusions A screen-and-treat approach for identifying and treating PTSD in adults following terrorist attacks appears cost-effective in England compared with treatment-as-usual through conventional primary care routes. Although this finding was in the context of terrorism, the implications might be translatable into other major incident-related scenarios including the current COVID-19 pandemic.

Item Type: Article
Official URL:
Additional Information: © 2021, The Author(s).
Divisions: Personal Social Services Research Unit
Health Policy
Subjects: R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
B Philosophy. Psychology. Religion > BF Psychology
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Date Deposited: 08 Oct 2021 16:45
Last Modified: 21 Nov 2021 19:03

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