Cost-effectiveness of brief psychodynamic-interpersonal therapy in high utilizers of psychiatric services.
BACKGROUND
It is known that a small number of patients with mental health problems have chronic disorders and account for a disproportionate amount of mental health costs. This randomized controlled trial evaluated the cost-effectiveness of psychodynamic-interpersonal therapy vs treatment as usual in patients with mental health problems who were unresponsive to usual treatment.


METHODS
Subjects (N = 110) with nonpsychotic disorders unresponsive to 6 months of routine specialist mental health treatment were enrolled in a randomized controlled trial. Sixty-three percent were women, the mean age was 41.4 years, the median duration of illness was 5 years, 68% were unemployed or receiving state benefits because of illness, and 75.5% had a depressive illness. Intervention patients received 8 weekly sessions of psychodynamic-interpersonal psychotherapy. Control patients received usual care from their psychiatrist. Outcome measures included ratings of psychological distress and health status and a detailed economic evaluation. Analysis was conducted on an intent-to-treat basis.


RESULTS
Subjects randomized to psychotherapy had a significantly greater improvement than controls in psychological distress and social functioning 6 months after the trial. Baseline treatment costs were similar for both groups. Subjects who received psychotherapy showed significant reductions in the cost of health care utilization in the 6 months after treatment compared with controls. The extra cost of psychotherapy was recouped within 6 months through reductions in health care use.


CONCLUSIONS
These preliminary findings suggest that brief psychodynamic-interpersonal therapy may be cost-effective relative to usual care for patients with enduring nonpsychotic symptoms who are not helped by conventional psychiatric treatment.
Guthrie
E
E
School of Psychiatry and Behavioural Sciences, University of Manchester, England. eguthrie@fs1.cmht.nwest.nhs.uk
Moorey
J
J
Margison
F
F
Barker
H
H
Palmer
S
S
McGrath
G
G
Tomenson
B
B
Creed
F
F
D000328:Adult; D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000191:economics / Q000523:psychology / Q000628:therapy; D004739:England; D005260:Female; D017048:Health Care Costs; D006296:Health Services / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000191:economics / Q000523:psychology / Q000628:therapy*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011614:Psychotherapy, Brief / Q000191:economics* / Q000379:methods; D011788:Quality of Life; D016896:Treatment Outcome