# A Mixed-Methods Economic Evaluation of Exposure and Response Prevention in Veterans with Obsessive-Compulsive Disorder

> **NIH VA I01** · MICHAEL E DEBAKEY VA MEDICAL CENTER · 2024 · —

## Abstract

Background and Significance: Obsessive-compulsive disorder (OCD) is a chronic and debilitating psychiatric
disorder affecting approximately 170,000 Veterans in the VHA. OCD involves obsessions (unwanted, intrusive
thoughts) and compulsions (repetitive mental or physical actions aimed at reducing distress). Individuals with
OCD experience significant functional impairments and have an increased odds for reporting a lifetime history
of suicide attempts. Despite the prevalence and functional impairment associated with OCD, few Veterans with
this condition receive Exposure and Response Prevention (ERP), the gold-standard intervention for OCD. ERP
is a behavioral treatment in which individuals are systematically exposed to feared situations that elicit distress
associated with OCD symptoms. In the VA, Veterans with OCD have a 2% chance of receiving this treatment.
To date, there is no data on the effectiveness of ERP for OCD in Veterans. The parent trial seeks to evaluate
the effectiveness of telehealth-delivered ERP for OCD in Veterans compared to a control condition, telehealth-
delivered Stress Management Training (SMT), within a hybrid type 1 effectiveness-implementation trial.
Primary outcomes include changes in functioning and secondary outcomes include the evaluation of ERP's
potential for implementation. In addition to evaluating the effectiveness of ERP, mixed-method economic
evaluations can help VA stakeholders evaluate tradeoffs between multiple strategies to address OCD in
Veterans and identify which interventions may have the greatest potential for adoption and sustainability.
Within mixed-method economic evaluation, quantitative analysis would include evaluating the health utilities of
Veterans with OCD (values associated with a particular health state) and a cost-effectiveness analysis (i.e., a
comparison of the difference in intervention costs to outcomes in OCD symptoms). Qualitative interviews would
provide information regarding context-specific factors affecting resources related to ERP delivery. Thus, the
aims of the current supplement are to understand the baseline health utility of Veterans with OCD as an
indicator of relative disease burden, to conduct a preliminary CEA of ERP for OCD, and conduct a qualitative
analysis of economic and resource-related factors as they pertain to ERP delivery. Research Plan: Aim 1:
Evaluate the health utility of Veterans wit OCD. This will be achieved by applying an algorithm to the Veterans
RAND-12, a generic measure of health-related quality of life. Aim 2: To conduct a cost effectiveness analysis
of ERP for changes in Quality Adjusted Life Years and OCD symptoms. This will be achieved by micro-costing
the ERP and SMT interventions to obtain an incremental cost-effectiveness ratio of the difference in costs
compared to difference in outcomes (i.e., OCD symptoms and Quality Adjusted Life Years). Aim 3: To evaluate
the contextual factors impacting the cost and resources required for ERP implement...

## Key facts

- **NIH application ID:** 10879793
- **Project number:** 3I01RX003677-02S1
- **Recipient organization:** MICHAEL E DEBAKEY VA MEDICAL CENTER
- **Principal Investigator:** Terri Lynn Fletcher
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 3
- **Project period:** 2022-06-01 → 2026-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10879793

## Citation

> US National Institutes of Health, RePORTER application 10879793, A Mixed-Methods Economic Evaluation of Exposure and Response Prevention in Veterans with Obsessive-Compulsive Disorder (3I01RX003677-02S1). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10879793. Licensed CC0.

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