Cost-Effectiveness of Psychotherapy for Cluster C Personality Disorders

Abstract

This study indicates that short-term day hospital psychotherapy and short-term inpatient psychotherapy are the most cost-effective treatment strategies for patients with cluster C personality disorders. The ultimate selection depends on what cost-effectiveness threshold is considered acceptable and what perspective is adopted.

Relationship between Patient Characteristics and Treatment Allocation for Patients with Personality Disorders

“…In this study we clustered these different treatments in terms of setting and duration. We opted to look first at setting and duration given that they have a profound influence on treatment costs and cost-effectiveness (Soeteman et al, 2010;Soeteman et al, 2011). With respect to setting, patients were either referred to (1) outpatient psychotherapy, up to a maximum of two sessions per week (n = 272; 29%), (2) day hospital psychotherapy, at least one morning/afternoon per week, mostly combined with psychosocial treatment (n = 311; 34%) or (3) inpatient psychotherapy, patients staying and sleeping at the institution five days a week, receiving different forms of psychotherapeutic and psychosocial treatment (n = 340; 37%).…”

Cost-Effective Psychotherapy for Personality Disorders in The Netherlands: The Value of Further Research and Active Implementation

“…We assumed probability parameters followed a Dirichlet distribution, a continuous distribution that is the multivariate generalization of the beta distribution. Details of model design and analyses have been described in previous publications [1,2].…”

“…Patient-level data were obtained from the largest existing clinical trial of psychotherapy for PDs (the SCEPTRE trial), which included over 900 patients [1,2]. Patients were assigned to one of the treatment groups, based on a comprehensive assessment battery combined with the expert opinion of clinicians.…”

“…Recently, two decision-analytic modeling studies evaluated the cost-effectiveness of various modalities of psychotherapy in treating cluster B personality disorders (PDs) [1], including borderline, antisocial, histrionic, and narcissistic PDs, and cluster C PDs [2], including avoidant, dependent, and obsessive-compulsive PDs. Results indicate that, at a societal willingness to pay of €40,000 per qualityadjusted life year (QALY), outpatient psychotherapy is the optimal treatment for patients with cluster B PDs, whereas short-term inpatient psychotherapy is the most cost-effective choice for patients with cluster C PDs.…”

New Directions in Treatment Research for Personality Disorders: Effectiveness of Different Levels of Care

“…Project SCEPTRE researchers have already begun to address such issues. For example, they recently presented data to show that short-term inpatient therapy is a cost-effective treatment for cluster C PD patients [20] . State-of-the-art cost-effectiveness analyses must consider not only the costs of delivering the treatments themselves, but also costs incurred outside the treatment setting, such as non-psychiatric medical costs, productivity costs and other indirect costs.…”