Feasibility, Effectiveness, and Cost-utility of Implementing a Reconsolidation-Based Trauma Treatment in the Aftermath of the November 15 Paris Terrorist Attacks

We report on the feasibility, effectiveness, and cost-utility of implementing evidence-based PTSD treatment to quickly enhance the capacities of a French public hospital network, in the weeks after the November 15 Paris attacks. A 2-arm, multicentric preference clinical trial and economic-evaluation compared the use of Reconsolidation Therapy (RT) to treatment-as-usual (TAU) for 332 adults, mostly with post-traumatic stress disorder (PTSD). RT involves recalling trauma under propranolol during a weekly 25-minute session for six consecutive weeks. Feasibility endpoints included the number of trained hospital personnel over two days and the number of participants choosing RT as their preferred treatment modality. The primary effectiveness endpoint was the delta scores in PTSD symptoms from baseline to Week 52. Cost-utility was evaluated by comparing RT to TAU. A large number of therapists (n = 160) were trained at various hospital sites over two days, and more participants opted for RT (n = 262) than TAU (n = 70), supporting feasibility endpoints. After 1 year, the mean PTSD symptom score decreased by 38.14 points (SD = 0.10) in the RT group and by 35.02 (SD = 1.68) for TAU (p = .297), indexing significant improvement in both groups. A significant difference of 5.11 points (SD = 2.50) in favor of RT (p = .041) emerged at Week 7, suggesting a faster initial recovery with RT vs. TAU. RT had a 55.4% probability of being the more effective and cheaper treatment compared to only 8.4% for TAU, outperforming TAU with a point-estimate saving of 27 150 euros per quality-adjusted life year (QALY). Annual sick leave costs were 4 147 euros (95%CI: 3 394 - 5 012) for RT versus 7 386 euros (95%CI: 5 416 - 10 340) for TAU (p = 0.01). Following massive trauma exposure, it is achievable to train mental health staff over 2 days in providing efficient evidence-based and cost-effective PTSD treatment. Findings await replication.