A cost-utility analysis of psychoanalysis versus psychoanalytic psychotherapy.
OBJECTIVE
Despite the considerable and growing body of research about the clinical effectiveness of long-term psychoanalytic treatment, relatively little attention has been paid to economic evaluations, particularly with reference to the broader range of societal effects. In this cost-utility study, we examined the incremental cost-effectiveness ratio (ICER) of psychoanalysis versus psychoanalytic psychotherapy.


METHODS
Incremental costs and effects were estimated by means of cross-sectional measurements in a cohort design (psychoanalysis, n = 78; psychoanalytic psychotherapy, n = 104). Quality-adjusted life-years (QALYs) were estimated for each treatment strategy using the SF-6D. Total costs were calculated from a societal perspective (treatment costs plus other societal costs) and discounted at 4 percent. Psychoanalysis was more costly than psychoanalytic psychotherapy, but also more effective from a health-related quality of life perspective. The ICER--that is, the extra costs to gain one additional QALY by delivering psychoanalysis instead of psychoanalytic psychotherapy--was estimated at 52,384 euros per QALY gained.


CONCLUSIONS
Our findings show that the cost-utility ratio of psychoanalysis relative to psychoanalytic psychotherapy is within an acceptable range. More research is needed to find out whether cost-utility ratios vary with different types of patients. We also encourage cost-utility analyses comparing psychoanalytic treatment to other forms of (long-term) treatment.
Berghout
Caspar C
CC
Netherlands Psychoanalytic Institute and VU University, Amsterdam, The Netherlands. berghout@npsai.nl
Zevalkink
Jolien
J
Hakkaart-van Roijen
Leona
L
D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000191:economics / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D010554:Personality Disorders / Q000191:economics / Q000628:therapy*; D011572:Psychoanalysis / Q000191:economics*; D011575:Psychoanalytic Therapy / Q000191:economics*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012737:Sex Factors; D012959:Socioeconomic Factors; D013997:Time Factors