Population-based cost–offset estimation for the treatment of borderline personality disorder: Projected costs in a currently running, ideal health system

Wunsch, Eva-Maria; Kliem, Sören; Kröger, Christoph

doi:10.1016/j.brat.2014.06.002

Cited by 22 publications

(19 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It presents with dysregulated affective states, often manifested by hostility and anger, which predispose to high physical aggression [ 19 , 20 ]. Treatment costs of BPD and lost productivity place a substantial economic burden on society, making BPD one of the most expensive mental disorders [ 21 ]. Although the mainstay of treatment for BPD is psychotherapy, pharmacological interventions play an important role in managing the disorder, evidenced by the fact that 40% of BPD patients take three or more psychotropic medications concurrently, 20% receive four or more medications, and 10% require greater than five psychotropic medications [ 22 ].…”

Section: Introductionmentioning

confidence: 99%

Elevated fatty acid amide hydrolase in the prefrontal cortex of borderline personality disorder: a [11C]CURB positron emission tomography study

Kolla

Mizrahi

Karas

et al. 2020

Neuropsychopharmacol.

View full text Add to dashboard Cite

Amygdala-prefrontal cortex (PFC) functional impairments have been linked to emotion dysregulation and aggression in borderline personality disorder (BPD). Fatty acid amide hydrolase (FAAH), the major catabolic enzyme for the endocannabinoid anandamide, has been proposed as a key regulator of the amygdala-PFC circuit that subserves emotion regulation. We tested the hypothesis that FAAH levels measured with [11C]CURB positron emission tomography in amygdala and PFC would be elevated in BPD and would relate to hostility and aggression. Twenty BPD patients and 20 healthy controls underwent FAAH genotyping (rs324420) and scanning with [11C]CURB. BPD patients were medication-free and were not experiencing a current major depressive episode. Regional differences in [11C]CURB binding were assessed using multivariate analysis of covariance with PFC and amygdala [11C]CURB binding as dependent variables, diagnosis as a fixed factor, and sex and genotype as covariates. [11C]CURB binding was marginally elevated across the PFC and amygdala in BPD (p = 0.08). In a priori selected PFC, but not amygdala, [11C]CURB binding was significantly higher in BPD (11.0%, p = 0.035 versus 10.6%, p = 0.29). PFC and amygdala [11C]CURB binding was positively correlated with measures of hostility in BPD (r > 0.4; p < 0.04). This study is the first to provide preliminary evidence of elevated PFC FAAH binding in any psychiatric condition. Findings are consistent with the model that lower endocannabinoid tone could perturb PFC circuitry that regulates emotion and aggression. Replication of these findings could encourage testing of FAAH inhibitors as innovative treatments for BPD.

show abstract

Section: Introductionmentioning

confidence: 99%

Elevated fatty acid amide hydrolase in the prefrontal cortex of borderline personality disorder: a [11C]CURB positron emission tomography study

Kolla

Mizrahi

Karas

et al. 2020

Neuropsychopharmacol.

View full text Add to dashboard Cite

show abstract

“…Other reviews that have looked at economic evaluations [ 17 , 18 , 56 ], similarly found evidence for cost-effective treatments for patients with BPD. To the best of our knowledge, there is no recent study that estimated annual net cost-savings of providing treatment in patients with BPD in a systematic way as conducted here.…”

Section: Discussionmentioning

confidence: 90%

The value of psychological treatment for borderline personality disorder: Systematic review and cost offset analysis of economic evaluations

et al. 2017

View full text Add to dashboard Cite

AimBorderline Personality Disorder (BPD) is a common mental health condition with high patterns of service utilisation of inpatient and community treatment. Over the past five years there has been significant growth in research with economic data, making this systematic review a timely update.MethodsEmpirical studies written in English or German, published up to December 2015, and cited in major electronic databases were examined using the PRISMA systematic review method. Papers were included that had one of the following: data related to cost of BPD to society, the individual, the carer or families; cost benefits of interventions. Reported cost data were inflated to the year 2015 and converted into US- dollars (USD $) using purchasing power parities.ResultsWe identified 30 economic evaluations providing cost data related to interventions for BPD across 134,136 patients. The methodological quality was good, almost all studies fulfilled ≥ 50% of the quality criteria. The mean cost saving for treating BPD with evidence-based psychotherapy across studies was USD $2,987.82 per patient per year. A further mean weighted reduction of USD $1,551 per patient per year (range $83 - $29,392) was found compared to treatment as usual. Evidence-based psychological treatment was both less expensive as well as more effective, despite considerable differences in health cost arrangements between individual studies and countries. Where it was able to be calculated, a significant difference in cost-savings between different types of evidence-based psychotherapies was found.DiscussionIndividuals with BPD consistently demonstrate high patterns of service utilization and therefore high costs. The findings of this review present a strong argument in favour of prioritizing BPD treatments in reimbursement decisions, both for the affected individual and the family. The provision of evidence based treatment, irrespective of the type of psychological treatment, may lead to widespread reductions in healthcare costs.

show abstract

“…Without adequate treatment BPD patients utilize a disproportionate amount of inpatient and outpatient psychiatric treatment resources, psychopharmacological treatments, crisis intervention, and other medical services (e.g., surgical care for self-injury, hospitalization after intoxications). The annual costs for untreated BPD in Germany are estimated to be 8.69 billion € annually (Wunsch et al, 2014). Most of the costs are incurred by hospitalizations and day treatment (Wagner et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Feasibility of Group Schema Therapy for Outpatients with Severe Borderline Personality Disorder in Germany: A Pilot Study with Three Year Follow-Up

et al. 2016

View full text Add to dashboard Cite

Borderline Personality Disorder (BPD) is a severe, challenging to treat mental disorder. Schema therapy (ST) as an individual therapy has been proven to be an effective psychological treatment for BPD. A group format of ST (GST) has been developed and evaluated in a randomized controlled trial in the United States and piloted in The Netherlands. These results suggest that GST speeds up and amplifies treatment effects of ST and might reduce delivery costs. However, feasibility in the German health care system and with BPD patients with high BPD severity and comorbidity, and frequent hospitalization, has not been tested to date. We investigated GST in 10 severely impaired, highly comorbid female patients with BPD, that needed frequent hospital admission. Patients received an outpatient ST-treatment program with weekly group and individual sessions for 1 year. Outcome measures including BPD severity, general psychopathology, psychosocial functioning, quality of life, happiness, schemas, and modes, and days of hospitalization were assessed at the start of treatment and 6, 12, and 36 months later with semi-structured interviews and self-report measures. We observed significant decreases in severity of BPD symptoms, general symptom severity, dysfunctional BPD-specific modes and schemas, and days of hospitalization. Functional modes, quality of live and happiness improved. The results of this feasibility study are promising and encourage further implementation of ST outpatient treatment programs even for patients with severe BPD and high hospitalization risk. However, small sample size and the missing of a control group do not allow the generalizability of these findings.

show abstract

Population-based cost–offset estimation for the treatment of borderline personality disorder: Projected costs in a currently running, ideal health system

Cited by 22 publications

References 29 publications

Elevated fatty acid amide hydrolase in the prefrontal cortex of borderline personality disorder: a [11C]CURB positron emission tomography study

Elevated fatty acid amide hydrolase in the prefrontal cortex of borderline personality disorder: a [11C]CURB positron emission tomography study

The value of psychological treatment for borderline personality disorder: Systematic review and cost offset analysis of economic evaluations

Feasibility of Group Schema Therapy for Outpatients with Severe Borderline Personality Disorder in Germany: A Pilot Study with Three Year Follow-Up

Contact Info

Product

Resources

About