Out-patient psychotherapy for borderline personality disorder: cost-effectiveness of schema-focused therapy v. transference-focused psychotherapy.
BACKGROUND
Schema-focused therapy (SFT) and transference-focused psychotherapy (TFP) for borderline personality disorder were recently compared in a randomised multicentre trial.


OBJECTIVE
To assess the societal cost-effectiveness of SFT v. TFP in treating borderline personality disorder.


METHODS
Costs were assessed by interview. Health-related quality of life was measured using EQ-5D. Outcomes were costs per recovered patient (recovery assessed with the Borderline Personality Disorder Severity Index) and costs per quality-adjusted life-year (QALY).


RESULTS
Mean 4-year bootstrapped costs were euro37 826 for SFT and euro46 795 for TFP (95% uncertainty interval for difference -21 775 to 3546); QALYs were 2.15 for SFT and 2.27 for TFP (95% UI -0.51 to 0.28). The percentages of patients who recovered were 52% and 29% respectively. The SFT intervention was less costly and more effective than TFP (dominant), for recovery; it saved euro90 457 for one QALY loss.


CONCLUSIONS
Despite the initial slight disadvantage in QALYs, there is a high probability that compared with TFP, SFT is a cost-effective treatment for borderline personality disorder.
van Asselt
Antoinette D I
AD
University Hospital Maastricht, Department KEMTA, PO Box 5800, 6202 AZ Maastricht, The Netherlands. avas@kemta.azm.nl
Dirksen
Carmen D
CD
Arntz
Arnoud
A
Giesen-Bloo
Josephine H
JH
van Dyck
Richard
R
Spinhoven
Philip
P
van Tilburg
Willem
W
Kremers
Ismay P
IP
Nadort
Marjon
M
Severens
Johan L
JL
D000328:Adult; D000553:Ambulatory Care / Q000191:economics* / Q000379:methods; D001883:Borderline Personality Disorder / Q000191:economics / Q000628:therapy*; D003362:Cost-Benefit Analysis; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands; D018187:Personal Construct Theory; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000191:economics* / Q000379:methods; D019057:Quality-Adjusted Life Years; D014167:Transference, Psychology; D016896:Treatment Outcome