Outpatient Psychotherapy Reduces Health-Care Costs: A Study of 22,294 Insurants over 5 Years

Abstract

BackgroundThe project “Quality Assurance in Ambulatory Psychotherapy in Bavaria” (QS-PSY-BAY) focuses on the quality assurance of outpatient psychotherapy (OPT) in Germany in terms of symptom reduction and cost reduction under naturalistic conditions. In this study, we examined the effectiveness of psychotherapy in terms of pre–post cost reduction.MethodThe health-care costs of N = 22,294 insurants over a 5-year period were examined in a naturalistic longitudinal design. Six participating health insurance funds provided data on costs related to inpatient treatment, outpatient treatment, drugs, and hospitalization and work disability days.ResultsWe found that the average annual total costs for inpatient and outpatient treatments as well as drug costs and work disability days increased from the second to the first year before OPT. Besides a large and significant reduction of work disability days (41.8%), hospitalization days (27.4%), and inpatient costs (21.5%) from the first year before versus the first year following OPT, we found evidence for long-term effects: the number of work disability days in the second year after OPT was lower (23.8%), and drug costs were higher than in the second year before OPT (41.5%).ConclusionWe conclude that OPT as a part of the health insurance system is an investment which can pay off in the future especially in terms of lower inpatient costs and work disability.

Outpatient Psychotherapy Improves Symptoms and Reduces Health Care Costs in Regularly and Prematurely Terminated Therapies

“…An inclusion criterion of the questionnaire study was that the patient was insured in one of the participating health insurance funds so that health care data could be tracked and provided. Previous studies focused on questionnaire data (Steffanowski et al, 2012; Altmann et al, 2014a,b, 2015; Strauss et al, 2015) or on cost data (Altmann et al, 2016). In the present study we analyzed for the first time merged dataset of questionnaire and cost data.…”

“…As psychotropic drugs antipsychotics (ATC Code: N05A), anxiolytics (N05B), hypnotics and sedatives (N05C), as well as antidepressants (N06A) were counted. Quarter sums were matched with questionnaire data whereby with quarter sums being adjusted to the beginning and the end of the considered psychotherapy (for more details see Strauss et al, 2015; Altmann et al, 2016). This was done because the examined outpatient psychotherapies did not all start in the same quarter.…”

“…With temporal distance of the reference quarter, the number of missing values increased. Missing values could be due to two reasons: individuals generated costs which were not documented or health-care costs which were not documented due to an individual's changed of the health insurance the individual's death (see Altmann et al, 2016). We tested if missing values were completely at random by using Little's MCAR test.…”

“…Accordingly, an increase of medical service contacts, costs, hospitalization days, and work disability days during the 2 years before inpatient (Zielke, 1993) as well as outpatient psychotherapy (Kraft et al, 2004, 2006; Altmann et al, 2016). Especially depression and anxiety are associated with an increased use of general medical services (Candilis and Pollack, 1997; Simon and Katzelnick, 1997).…”

“…Most of them were psychological family interventions. Due to the need for cost analyses for outpatient psychotherapy of persons suffering from mental disorder (Chiles et al, 1999), a current study (Altmann et al, 2016) examined a disorder heterogeneous sample of 22,294 persons who were treated with outpatient therapy with cognitive behavioral therapy, psychodynamic therapy or psychoanalysis under naturalistic conditions. The authors found that direct health care costs were reduced by 10.1% on average of the costs in the year before outpatient psychotherapy, hospitalization days by 27.4%, and work disability days by 41.8%.…”