Cost-effectiveness of psychotherapy for cluster B personality disorders.
BACKGROUND
Recommendations on current clinical guidelines are informed by limited economic evidence.


OBJECTIVE
A formal economic evaluation of three modalities of psychotherapy for patients with cluster B personality disorders.


METHODS
A probabilistic decision-analytic model to assess the cost-effectiveness of out-patient, day hospital and in-patient psychotherapy over 5 years in terms of cost per recovered patient-year and cost per quality-adjusted life-year (QALY). Analyses were conducted from both societal and payer perspectives.


RESULTS
From the societal perspective, the most cost-effective choice switched from out-patient to day hospital psychotherapy at a threshold of 12,274 euros per recovered patient-year; and from day hospital to in-patient psychotherapy at 113,298 euros. In terms of cost per QALY, the optimal strategy changed at 56,325 euros and 286,493 euros per QALY respectively. From the payer perspective, the switch points were at 9895 euros and 155,797 euros per recovered patient-year, and 43,427 euros and 561,188 euros per QALY.


CONCLUSIONS
Out-patient psychotherapy and day hospital psychotherapy are the optimal treatments for patients with cluster B personality disorders in terms of cost per recovered patient-year and cost per QALY.
Soeteman
Djøra I
DI
Department of Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, The Netherlands. Djora.Soeteman@deviersprong.nl
Verheul
Roel
R
Delimon
Jos
J
Meerman
Anke M M A
AM
van den Eijnden
Ellen
E
Rossum
Bert V
BV
Ziegler
Uli
U
Thunnissen
Moniek
M
Busschbach
Jan J V
JJ
Kim
Jane J
JJ
D000328:Adult; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003631:Day Care, Medical / Q000191:economics; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D009426:Netherlands; D010044:Outpatient Clinics, Hospital / Q000191:economics; D010554:Personality Disorders / Q000191:economics / Q000628:therapy*; D011613:Psychotherapy / Q000191:economics* / Q000379:methods; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome; D055815:Young Adult