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Preference-Weighted Health Status of PTSD Among Veterans: An Outcome for Cost-Effectiveness Analysis Using Clinical Data

Dr. Freed, Dr. Liu, Dr. Gore, and Dr. Engel are affiliated with the Deployment Health Clinical Center, Walter Reed Army Medical Center, Building 2, Room 3E01, 6900 Georgia Ave., N.W., Washington, D.C. 20307 (e-mail: mc_freed{at}onebox.com). They are also with the Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md. Mr. Yeager and Dr. Magruder are with the Ralph H. Johnson Veterans Affairs Medical Center and the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston.

OBJECTIVE: Posttraumatic stress disorder (PTSD) is a highly prevalent, chronic, disabling but treatable condition. Preference-based measures (for example, health utilities) are recommended for and useful in cost-effectiveness analyses and for policy decisions because they reflect a population's valuation of the desirability of disease states. However, no such measures exist for PTSD. This study aimed to estimate preference-weighted health status associated with PTSD and common co-occurring mental disorders in a sample of veterans by transforming health-related quality-of-life data into preference-weighted health status scores (PWHS scores), develop a usable regression model to predict PWHS scores from other data sets, and compare preference-weighted health status of PTSD with that of another chronic disorder, chronic obstructive pulmonary disease (COPD). METHODS: A secondary analysis was performed on data from a random sample of 808 veterans (79% male; 12% met criteria for PTSD) in four primary care clinics. Veterans responded to the PTSD Checklist (PCL), Clinician-Administered PTSD Scale, Mini-International Neuropsychiatric Interview, and Medical Outcomes Survey Short Form-36. RESULTS:PWHS scores were .029 lower among veterans with PTSD compared with veterans without PTSD, all else being equal. However, scores depended on PTSD severity, when the analysis controlled for other model variables. Specifically, PWHS scores dropped by .004 with a 1-unit increase in PCL scores among veterans without PTSD. Among veterans with PTSD, the reduction was .002. PTSD was associated with lower preference-weighted health status than COPD. CONCLUSIONS: This is the first study to estimate preference-weighted health status of persons with PTSD. These PWHS scores can be helpful in cost-effectiveness studies of PTSD treatments.

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Psychiatr Serv 2009 60: 1163. [Full Text] [PDF]

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