Clinical and cost-effectiveness of eye movement desensitization and reprocessing for treatment and prevention of post-traumatic stress disorder in adults: A systematic review and meta-analysis.

Abstract

The objective was to provide up-to-date clinical and cost-effectiveness evidence investigating eye movement desensitization and reprocessing (EMDR) for treatment or prevention of adult post-traumatic stress disorder (PTSD). We conducted a systematic review of randomized controlled trials (RCTs) and cost-effectiveness studies assessing PTSD symptoms in adults, published since the NICE 2018 guidelines. EMDR was compared with trauma-focused-cognitive behavioural therapy (TF-CBT), waitlist or usual care. Six databases were searched in September 2023. Risk of bias was assessed. Data synthesis included Bayesian meta-analyses of standardized mean differences if sufficient data were available from at least three RCTs. From 2038 records, 17 studies met the eligibility criteria. One modelling-based study reported cost-effectiveness, finding EMDR the most cost-effective intervention compared to 10 others, including TF-CBT. Sixteen RCTs (n = 1031) providing clinical PTSD outcome data were identified. Most studies had small sample sizes, and all but one was at high/moderate risk of bias. Additionally, 13 RCTs from NICE 2018 guidelines contributed to meta-analyses. EMDR treatment was generally of shorter duration with a lower burden on patient time. Meta-analyses found EMDR was statistically significantly better than waitlist/usual care. There was no significant difference in treatment effect between EMDR and TF-CBT, both reported significantly improved PTSD symptoms.