{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T05:25:41Z","timestamp":1782451541968,"version":"3.54.5"},"reference-count":36,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T00:00:00Z","timestamp":1704067200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["MDM Policy &amp; Practice"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:p> Background. Global climate change is resulting in dramatic increases in wildfires. Individuals exposed to wildfires experience a high burden of posttraumatic stress disorder (PTSD), and the cost-effectiveness of the treatment options to address PTSD from wildfires has not been studied. The objective of this study was to conduct a cost-utility analysis comparing screening followed by treatment with paroxetine or trauma-focused cognitive behavioral therapy (TF-CBT) versus no screening in Canadian adult wildfire evacuees. Methods. Using a Markov model, quality-adjusted life-years (QALYs) and costs were evaluated over a 5-y time horizon using health care and societal perspectives. All costs and utilities in the model were discounted at 1.5%. Probabilistic and deterministic sensitivity analyses examined the uncertainty in the incremental net monetary benefit (INMB) under a willingness-to-pay threshold of $50,000. Results. From a societal perspective, no screening (NMB\u2009=\u2009$177,641) was dominated by screening followed by treatment with paroxetine (NMB\u2009=\u2009$180,733) and TF-CBT (NMB\u2009=\u2009$181,787), with TF-CBT having the highest likelihood of being cost-effective at a willingness-to-pay threshold of $50,000 per QALY (probability\u2009=\u20090.649). The initial prevalence of PTSD, probability of acceptance of treatment, and costs of productivity had the largest impact on the INMB of both paroxetine or TF-CBT versus no screening. Neither intervention was cost-effective at a willingness-to-pay threshold of $50,000 per QALY from a health care perspective. Interpretation. Screening followed by treatment with paroxetine or TF-CBT compared with no screening was found to be cost-saving while providing additional QALYs in wildfire evacuees. Governments should consider funding screening programs for PTSD followed by treatment with TF-CBT for wildfire evacuees. <\/jats:p><jats:sec><jats:title>Highlights<\/jats:title><jats:p> Two prior studies examined the cost-effectiveness of screening followed by treatment for PTSD among individuals exposed to other disaster-type events (i.e., terrorist attack and Hurricane Sandy) and found screening followed by treatment (i.e., cognitive behavioral therapy [CBT]) to be highly cost-effective. Among wildfire evacuees, screening followed by treatment with paroxetine or trauma-focused (TF)\u2013CBT provides additional quality-adjusted life-years (QALYs) and is cost-saving from a societal perspective. TF-CBT was the treatment option found most likely to be cost-effective. Neither treatment option was cost-effective at a willingness-to-pay threshold of $50,000 per QALY from a health care perspective. Screening programs for PTSD should be considered for wildfire evacuees, and individuals diagnosed with PTSD could be prescribed either TF-CBT or paroxetine depending on their preference and resources availability. <\/jats:p><\/jats:sec>","DOI":"10.1177\/23814683241260423","type":"journal-article","created":{"date-parts":[[2024,6,19]],"date-time":"2024-06-19T07:46:10Z","timestamp":1718783170000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Screening and Treatment of Posttraumatic Stress Disorder in Wildfire Evacuees: A Cost-Utility Analysis"],"prefix":"10.1177","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6319-3466","authenticated-orcid":false,"given":"Michael","family":"Lebenbaum","sequence":"first","affiliation":[{"name":"Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada"},{"name":"Canadian Centre for Health Economics, Toronto, ON, Canada"},{"name":"Center for Demography of Health and Aging, University of Wisconsin\u2013Madison, Madison, WI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. Ahmed","family":"Hassan","sequence":"additional","affiliation":[{"name":"Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,6,19]]},"reference":[{"key":"bibr1-23814683241260423","doi-asserted-by":"publisher","DOI":"10.1016\/j.envint.2019.04.025"},{"key":"bibr2-23814683241260423","author":"Thurton D.","year":"2019","journal-title":"CBC"},{"key":"bibr3-23814683241260423","unstructured":"CBC Radio. 2 months after Lytton, B.C., was destroyed by fire, its future is still unclear. 2021. Available from: https:\/\/www.cbc.ca\/radio\/thecurrent\/the-current-for-sept-7-2021-1.6166608\/2-months-after-lytton-b-c-was-destroyed-by-fire-its-future-is-still-unclear-1.6171191"},{"key":"bibr4-23814683241260423","author":"Austen I","year":"2023","journal-title":"New York Times"},{"key":"bibr5-23814683241260423","doi-asserted-by":"publisher","DOI":"10.3390\/bs11090126"},{"key":"bibr6-23814683241260423","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph16091604"},{"key":"bibr7-23814683241260423","doi-asserted-by":"publisher","DOI":"10.1111\/j.1755-5949.2008.00049.x"},{"key":"bibr8-23814683241260423","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0059236"},{"key":"bibr9-23814683241260423","doi-asserted-by":"publisher","DOI":"10.1080\/10538712.2013.743953"},{"key":"bibr10-23814683241260423","doi-asserted-by":"publisher","DOI":"10.1017\/S1041610215001775"},{"key":"bibr11-23814683241260423","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-049472"},{"key":"bibr12-23814683241260423","doi-asserted-by":"publisher","DOI":"10.1186\/1471-244X-14-S1-S1"},{"key":"bibr13-23814683241260423","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10184175"},{"key":"bibr14-23814683241260423","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291720000070"},{"key":"bibr15-23814683241260423","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0232245"},{"key":"bibr16-23814683241260423","doi-asserted-by":"publisher","DOI":"10.1177\/0004867414553948"},{"key":"bibr17-23814683241260423","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2017.3037"},{"key":"bibr18-23814683241260423","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2019.00623"},{"key":"bibr19-23814683241260423","doi-asserted-by":"publisher","DOI":"10.1007\/s10488-021-01114-w"},{"key":"bibr20-23814683241260423","unstructured":"Alberta College of Family Physicians. Price comparison of commonly prescribed pharmaceuticals in Alberta 2018. 2018. Available from: https:\/\/acfp.ca\/wp-content\/uploads\/2018\/03\/ACFPPricingDoc2018.pdf"},{"key":"bibr21-23814683241260423","unstructured":"Ontario Health Insurance Plan (OHIP). OHIP schedule of benefits. 2021. Available from: https:\/\/www.health.gov.on.ca\/en\/pro\/programs\/ohip\/sob\/"},{"key":"bibr22-23814683241260423","unstructured":"CBT Associates. Rates and fees. 2021. Available from: https:\/\/www.cbtassociates.com\/about-us\/rates-fees\/"},{"key":"bibr23-23814683241260423","unstructured":"Statistics Canada. Income of individuals by age group, sex and income source, Canada, provinces and selected census metropolitan areas. 2020. Available from: https:\/\/www150.statcan.gc.ca\/t1\/tbl1\/en\/tv.action?pid=1110023901"},{"key":"bibr24-23814683241260423","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.21m14116"},{"key":"bibr25-23814683241260423","doi-asserted-by":"publisher","DOI":"10.1111\/1753-6405.12004"},{"key":"bibr26-23814683241260423","doi-asserted-by":"publisher","DOI":"10.2165\/00023210-200418130-00006"},{"key":"bibr27-23814683241260423","unstructured":"Statistics Canada. Life tables, Canada, provinces and territories 1980\/1982 to 2017\/2019 Note. 2020. Available from: https:\/\/www150.statcan.gc.ca\/n1\/pub\/84-537-x\/84-537-x2020001-eng.htm"},{"key":"bibr28-23814683241260423","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.20476"},{"key":"bibr29-23814683241260423","unstructured":"Statistics Canada. Consumer price index, annual average, not seasonally adjusted. 2021. Available from: https:\/\/www150.statcan.gc.ca\/t1\/tbl1\/en\/cv.action?pid=1810000501"},{"key":"bibr30-23814683241260423","doi-asserted-by":"publisher","DOI":"10.1080\/20008198.2020.1753940"},{"key":"bibr31-23814683241260423","unstructured":"Statistics Canada. Average weekly earnings by industry, annual. 2022. Available from: https:\/\/www150.statcan.gc.ca\/t1\/tbl1\/en\/tv.action?pid=1410020401"},{"key":"bibr32-23814683241260423","doi-asserted-by":"publisher","DOI":"10.1007\/s10803-015-2447-0"},{"key":"bibr33-23814683241260423","volume-title":"Guidelines for the Economic Evaluation of Health Technologies: Canada","author":"Canadian Agency for Drugs and Technologies in Health","year":"2017","edition":"4"},{"key":"bibr34-23814683241260423","doi-asserted-by":"publisher","DOI":"10.2147\/CEOR.S264589"},{"key":"bibr35-23814683241260423","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2012.04.014"},{"key":"bibr36-23814683241260423","unstructured":"Lanitis T, Muszbek N, Tichy E. The probability of a successful probabilistic sensitivity analysis. The Evidence Forum. 2014. Available from: https:\/\/www.evidera.com\/wp-content\/uploads\/2015\/04\/The-Probability-of-a-Successful-Probabilistic-Sensitivity-Analysis.pdf"}],"container-title":["MDM Policy &amp; Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23814683241260423","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/23814683241260423","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23814683241260423","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,2]],"date-time":"2025-03-02T16:27:54Z","timestamp":1740932874000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/23814683241260423"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1]]},"references-count":36,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024,1]]}},"alternative-id":["10.1177\/23814683241260423"],"URL":"https:\/\/doi.org\/10.1177\/23814683241260423","relation":{},"ISSN":["2381-4683","2381-4683"],"issn-type":[{"value":"2381-4683","type":"print"},{"value":"2381-4683","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1]]},"article-number":"23814683241260423"}}