Prolonged Exposure or Cognitive Processing Therapy May Reduce Use of Mental Health Services in Veterans with PTSD
BACKGROUND:
The wars in Iraq and Afghanistan have led to an increased need for mental health services, particularly for the treatment of PTSD, which has been found to affect up to 25% of newly returning Veterans seeking VA healthcare. In response, VA and the DoD have recommended the use of Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) for PTSD. Following this recommendation, VA established the policy that all Veterans diagnosed with PTSD have access to either PE or CPT, and implemented a nationwide dissemination initiative to ensure access to these treatments at every facility. This study evaluated the impact of a course of PE or CPT on VA mental health and medical service utilization and healthcare costs. Using VA data, investigators identified 70 Veterans (75% male) who successfully completed outpatient treatment with CPT or PE at one Midwestern VAMC, and who had significant levels of trauma-related symptoms. Most patients (91%) had a chart diagnosis of PTSD; 66% had a comorbid diagnosis of depression; and 21% had a comorbid diagnosis of substance use disorder. Veterans receiving CPT (n=39) completed a standard 12-week protocol of group and individual sessions, while those receiving PE (n=31) completed an average of 13 individual sessions. Costs for the 12 months prior to starting therapy were compared with the 12 months after completing therapy (excluding costs during treatment).
FINDINGS:
- Veterans who had successfully completed Prolonged Exposure (PE) or Cognitive Processing Therapy (CPT) for PTSD experienced a reduction of both PTSD and depression symptomatology; they also reduced their mental health service utilization by 32% in the year following treatment when compared to the year prior to the initiation of PE or CPT.
- There was a slight, non-significant decline in primary care usage among Veterans who had completed therapy, while emergency department usage remained virtually the same.
- Per Veteran, there was a 39% reduction in total costs — from an average of $5,173 in the year prior to treatment to $3,133 in the year following treatment.
- These preliminary findings suggest that the successful completion of PE and CPT for the treatment of PTSD significantly reduces mental health service use and outweighs the cost of treatment.
LIMITATIONS:
- The sample size was relatively small, was collected at only one clinical site, and did not include patients who initiated but did not complete therapy.
- Because identifying an adequate control group was not possible, it is not possible to attribute conclusively all of the improvement to CPT or PE therapy.
AUTHOR/FUNDING INFORMATION:
Dr. Kehle-Forbes is supported by an HSR&D Career Development Award (CDA 09-020), and she is part of HSR&D's Center for Chronic Disease Outcomes Research, Minneapolis.
Meyers L, Strom T, Thuras P, Leskela J, Kehle-Forbes S, and Curry K. Service Utilization Following Participation in Cognitive Processing Therapy or Prolonged Exposure Therapy for Post-Traumatic Stress Disorder. Military Medicine January 2013;178(1):95-99.
