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

BackgroundIn response to the Bataclan terrorist attacks, the deadliest on French soil since World War II, the Paris Memoire Vive (PARIS MEM) project was launched to expand the public hospital networks capacity to treat trauma-related disorders. Reconsolidation Therapy (RT), a brief evidence-based intervention for post-traumatic stress disorder (PTSD), was selected for rapid implementation across hospital sites. ObjectiveTo evaluate the feasibility, effectiveness, and cost-utility of implementing RT to enhance public hospital treatment capacity after mass trauma exposure. MethodA two-arm, multicentric, preference-based clinical trial and economic evaluation compared RT to treatment-as-usual (TAU) in 332 adults, mostly with PTSD. RT involves recalling trauma under propranolol during six weekly 25-minute sessions. Feasibility endpoints included the number of hospital staff trained and the proportion of participants choosing RT. The primary effectiveness endpoint was the delta scores in PTSD symptoms from baseline to Week 52. Cost-utility was evaluated using incremental cost-effectiveness ratios and quality-adjusted life years (QALYs). ResultsAcross hospital sites, 160 therapists were trained in two days, and more participants opted for RT (n = 262) over TAU (n = 70), supporting feasibility endpoints. After one year, mean PTSD symptom scores decreased by 38.14 points (SD = 0.10) in RT and 35.02 (SD = 1.68) in TAU (p = .297), indexing significant improvement in both groups. At Week 7, RT showed faster initial recovery (difference = -5.11; p = .041). RT had a 55.4% probability of being cheaper and more effective than TAU (8.4%), with estimated savings of 27150{euro} per QALY. Annual sick-leave costs were lower for RT (4147{euro}; 95% CI = 3 394-5 012) than TAU (7 386{euro}; 95% CI = 5 416-10 340; p = .01). ConclusionsFollowing massive trauma exposure, training mental health staff over two days in providing efficient, evidence-based, cost-effective PTSD treatment is achievable. Findings await replication. Trial RegistrationNCT02789982. HighlightsO_LIIt is feasible to train a large cohort of therapists in the aftermath of mass trauma and enhance the treatment capacities of institutions. C_LIO_LIReconsolidation Therapy worked faster than treatment as usual in the alleviation of traumatic stress symptoms. C_LIO_LIReconsolidation Therapy emerges as a cost-effective treatment, being both cheaper and more effective in 55% of cases. C_LI