Cost Effectiveness of Adjunctive Neurofeedback vs. Psychotherapy or Pharmacotherapy for Post-Traumatic Stress Disorder

<b>Background:</b> Neurofeedback shows promise as an adjunctive therapy for post-traumatic stress disorder (PTSD), but its cost effectiveness has not been studied. <b>Objectives:</b> To assess the cost and effectiveness of neurofeedback plus other therapies (NF + OT) vs. guideline therapies alone. <b>Methods:</b> TreeAge software was used to develop Markov models comparing NF + OT therapy to psychotherapy and pharmacotherapy over 1-3 years. Costs were derived from Medicare rates and literature. Effectiveness was measured using CAPS-5 score reductions converted to quality-adjusted life years (QALYs) using regression analysis. Dropout and relapse rates were derived from systematic reviews and meta-analysis. <b>Results:</b> NF + OT resulted in greater improvements in CAPS-5 scores and was less costly than OT. In the base case, NF + OT was less expensive (on average) for years 1-3 by USD 2568-USD 4140 (vs. psychotherapy) and USD 2282-USD 7217 (vs. pharmacotherapy). QALYs improved by 0.04 compared to psychotherapy and 0.24 compared to pharmacotherapy. NF + OT dominated (lower cost, better outcomes) psychotherapy 12% of the time and pharmacotherapy 26.5% of the time in Monte Carlo simulation. Further, Monte Carlo simulation did not demonstrate dominance at any point in time for either pharmacotherapy or psychotherapy over NF + OT. <b>Conclusions:</b> Based on lower costs and improved effectiveness, NF + OT should be considered for treating PTSD.