Washington State Institute for Public Policy
Cognitive behavioral therapy (CBT) for adult posttraumatic stress disorder (PTSD)
Adult Mental Health: Trauma
Benefit-cost estimates updated May 2017.  Literature review updated September 2016.
Treatments in this review include several components, such as psycho-education about posttraumatic stress disorder (PTSD), relaxation and other techniques for managing physiological and emotional stress, exposure (the gradual desensitization to memories of the traumatic event), and cognitive restructuring of inaccurate or unhelpful thoughts. The studies in this review employed a number of trauma-specific treatment models including Prolonged Exposure Therapy (PE), Narrative Exposure Therapy (NET), and Cognitive Processing Therapy (CPT). In the studies in this review, treatments provided between 1-45 therapeutic hours per client in individual or group settings. Studies were conducted on all continents and subjects had experienced one of a variety of types of trauma including terrorism, sexual or physical assault, domestic violence, war, political detention, and automobile accidents.
BENEFIT-COST
META-ANALYSIS
CITATIONS
The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2016). The chance the benefits exceed the costs are derived from a Monte Carlo risk analysis. The details on this, as well as the economic discount rates and other relevant parameters are described in our Technical Documentation.
Benefit-Cost Summary Statistics Per Participant
Benefits to:
Taxpayers $15,791 Benefits minus costs $49,184
Participants $27,660 Benefit to cost ratio $88.11
Others $4,695 Chance the program will produce
Indirect $1,602 benefits greater than the costs 100 %
Total benefits $49,748
Net program cost ($565)
Benefits minus cost $49,184
1In addition to the outcomes measured in the meta-analysis table, WSIPP measures benefits and costs estimated from other outcomes associated with those reported in the evaluation literature. For example, empirical research demonstrates that high school graduation leads to reduced crime. These associated measures provide a more complete picture of the detailed costs and benefits of the program.

2“Others” includes benefits to people other than taxpayers and participants. Depending on the program, it could include reductions in crime victimization, the economic benefits from a more educated workforce, and the benefits from employer-paid health insurance.

3“Indirect benefits” includes estimates of the net changes in the value of a statistical life and net changes in the deadweight costs of taxation.
Detailed Monetary Benefit Estimates Per Participant
Benefits from changes to:1 Benefits to:
Taxpayers Participants Others2 Indirect3 Total
Labor market earnings associated with PTSD $12,000 $26,425 $0 $0 $38,425
Health care associated with PTSD $3,791 $1,235 $4,695 $1,884 $11,605
Adjustment for deadweight cost of program $0 $0 $0 ($282) ($282)
Totals $15,791 $27,660 $4,695 $1,602 $49,748
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $1,444 2014 Present value of net program costs (in 2016 dollars) ($565)
Comparison costs $814 2008 Cost range (+ or -) 15 %
These therapies can take place over 1-45 weekly sessions; total length of treatment is less than one year. The per-participant cost of treatment by modality (group/individual) was weighted by the treatment Ns reported in the studies. Cost per session is $40.04/session for group and $122.25 for individual therapy (2015 dollars). This rate is based on actuarial tables reported in Mercer (2014) Behavioral Health Data Book for the State of Washington For Rates Effective January 1, 2015. The comparison group costs are from the average Medicaid expenditures for PTSD treatment in Washington in 2009.
The figures shown are estimates of the costs to implement programs in Washington. The comparison group costs reflect either no treatment or treatment as usual, depending on how effect sizes were calculated in the meta-analysis. The cost range reported above reflects potential variation or uncertainty in the cost estimate; more detail can be found in our Technical Documentation.
Estimated Cumulative Net Benefits Over Time (Non-Discounted Dollars)
The graph above illustrates the estimated cumulative net benefits per-participant for the first fifty years beyond the initial investment in the program. We present these cash flows in non-discounted dollars to simplify the “break-even” point from a budgeting perspective. If the dollars are negative (bars below $0 line), the cumulative benefits do not outweigh the cost of the program up to that point in time. The program breaks even when the dollars reach $0. At this point, the total benefits to participants, taxpayers, and others, are equal to the cost of the program. If the dollars are above $0, the benefits of the program exceed the initial investment.

^WSIPP’s benefit-cost model does not monetize this outcome.

^^WSIPP does not include this outcome when conducting benefit-cost analysis for this program.

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic in order to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the types of program impacts that were measured in the research literature (for example, crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases.

Adjusted effect sizes are used to calculate the benefits from our benefit cost model. WSIPP may adjust effect sizes based on methodological characteristics of the study. For example, we may adjust effect sizes when a study has a weak research design or when the program developer is involved in the research. The magnitude of these adjustments varies depending on the topic area.

WSIPP may also adjust the second ES measurement. Research shows the magnitude of some effect sizes decrease over time. For those effect sizes, we estimate outcome-based adjustments which we apply between the first time ES is estimated and the second time ES is estimated. We also report the unadjusted effect size to show the effect sizes before any adjustments have been made. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured Primary or secondary participant No. of effect sizes Treatment N Adjusted effect sizes (ES) and standard errors (SE) used in the benefit-cost analysis Unadjusted effect size (random effects model)
First time ES is estimated Second time ES is estimated
ES SE Age ES SE Age ES p-value
Anxiety disorder 17 355 -0.620 0.087 40 -0.620 0.087 41 -0.948 0.001
Employment^^ 1 12 0.348 0.530 40 0.348 0.530 41 0.821 0.125
Major depressive disorder 49 1389 -0.433 0.046 40 -0.433 0.046 41 -0.717 0.001
Post-traumatic stress 70 2361 -0.539 0.047 40 -0.539 0.047 41 -0.950 0.001
Substance misuse^ 1 55 -0.164 0.366 40 -0.164 0.366 41 -0.261 0.477
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For more information on the methods
used please see our Technical Documentation.
360.664.9800
institute@wsipp.wa.gov