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

Abstract

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.

Clinician attitudes towards borderline personality disorder: A 15‐year comparison

“…The inclusion of certain terms for the 2015 sample indicating treatment practice (e.g. ‘management plan’ and ‘multidisciplinary team’) may reflect the changing nature of treatment within the mental health system in response to improved prognosis and evidence‐based treatments for individuals with BPD . At the beginning of this paper, Thornicroft, Brohan, Kassam and Lewis‐Holmes was cited, which proposed stigma to be a result of three interrelated problems: knowledge, attitudes and behaviour.…”

“…With effective training for clinicians in the effective treatment of BPD being labelled a mental health priority, improved access to research and targeted training programmes are increasingly offered to mental health professionals . Further, a recent systematic review revealed average cost savings of $US2 987.82 per patient per year when implementing evidence‐based interventions . This is reflected in the changing landscape of the mental health service, with BPD being increasingly seen as a legitimate and treatable mental health condition with economic incentives for effective treatment.…”

A 1‐year follow‐up study of capacity to love and work: What components of borderline personality disorder most impair interpersonal and vocational functioning?

“…There is a need to study psychosocial functioning more broadly, and expanding this area of research is also strongly supported by people with lived experience . Indeed, economic evaluations point to the benefits of treatment not only in terms of financial benefits for the patient and savings to the health system but also society gains from greater productivity and paying taxes . In order to further develop treatments targeting function, a comprehensive understanding of what factors may contribute to persistent psychosocial impairment is required.…”

Mentalization‐based treatment or psychodynamic treatment programmes for patients with borderline personality disorder – the impact of clinical severity

“…In addition, it is noteworthy that major societal costs are associated with psychosocial and occupational impairments typical of severe personality disorder, including features of both BPD, paranoid or avoidant PD (Wilberg, Karterud, Pedersen, & Urnes, ; Zanarini, Frankenburg, Reich, & Fitzmaurice, ). Accordingly, improvement of social impairments may also contribute to balancing high treatment costs (Meuldijk et al ., ). The present study interestingly indicates that comorbid avoidant PD traits in particular distinguished long‐term effects of MBT from PDT.…”

“…Evidence base for treatment interventions should include studies of indications and contraindications (Choi-Kain, Albert, & Gunderson, 2016;Feenstra, Luyten, & Bales, 2017;Meuldijk, McCarthy, Bourke, & Grenyer, 2017). The current study is one of few BPD treatment studies focusing on impacts of comorbidity and severity.…”