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Treatment strategies for refractory OCD: cost-effectiveness analysis



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Partial hospitalization followed by intensive outpatient treatment was the most cost-effective strategy for treatment-refractory OCD. according to data from the Journal of Clinical Psychiatry .

Researchers developed a decision-analytic model for stratification of outpatient treatment strategies and a Markov model for the accumulation of benefits, costs and mortality for a hypothetical cohort of 1

00,000 adults (18-64 years old) with treatment-resistant OCD. The researchers identified 7 treatment strategies from the existing literature, starting with 2 pharmacological models: antidepressant (ADM) monotherapy and ADM therapy with antipsychotics. The researchers then identified 5 strategies for polytherapy with ADMs and cognitive-behavioral therapy (ADM-CBT).

Two similar ADM-CBT treatment models extracted from the literature differed in CBT dosing and fineness, with 1 being by trial and error efficacy (ADM + CBT) and the other by practical efficacy (ADM + CBT). [effectiveness]). Of the 3 final ADM-CBT strategies, 1 included intensive outpatient treatment (IOP), 1 partial hospitalization (PHP), and 1 a step-down strategy that steered the transition from PHP to IOP (PHP / IOP).

The PHP / IOP strategy resulted in the highest net health benefit of the 7 strategies, with an average of 10.96 quality-adjusted life years after treatment. This result was 2.2 quality-adjusted life years higher than the next-best-score strategy (ADM + CBT), which represents a greater average life-years improvement for the average person in PHP / IOP compared to the average person in ADM + CBT ,

The researchers then calculated an incremental cost-effectiveness ratio of $ 7,983 for each strategy, with PHP / IOP having the highest incremental cost-benefit ratio of all treatments. The additional ADM-CBT strategies were not statistically significantly different ( P > .05), although all ADM-CBT strategies outperformed both pharmacotherapeutic and drug-only strategies. In the simulation model, CBT provided in an IOP, PHP, or clinical trial scenario (ADM + CBT) was superior to real CBT (ADM + CBT [effectiveness]).

Given the limited availability of high-quality CBT in real-world scenarios, researchers concluded that specialized treatment programs with partial hospitalization and a step-down strategy may provide greater efficacy in achieving wellness for this patient population.

These analyzes reinforce current knowledge that ADM-CBT combination therapies are generally more effective than pharmaceutical monotherapy, and suggest that specialized treatment protocols may be more effective in refractory OCD. The cost-effectiveness data can also provide clinicians with useful information in developing individualized intervention strategies for patients with treatment-resistant OCD.

Reference

Gregory ST, Kay B, Smith J, et al. Therapy-Refractory OCD in adults: a cost-benefit analysis of treatment strategies. J Clin Psychiatry . 2018; 79 (2): 17m11552.


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