title: Societal cost-of-illness in patients with borderline personality disorder one year before, during and after dialectical behavior therapy in routine outpatient care.
abstract: Societal cost-of-illness in a German sample of patients with borderline personality disorder (BPD) was calculated for 12 months prior to an outpatient Dialectical Behavior Therapy (DBT) program, during a year of DBT in routine outpatient care and during a follow-up year. We retrospectively assessed resource consumption and productivity loss by means of a structured interview. Direct costs were calculated as opportunity costs and indirect costs were calculated according to the Human Capital Approach. All costs were expressed in Euros for the year 2010. Total mean annual BPD-related societal cost-of-illness was €28026 (SD = €33081) during pre-treatment, €18758 (SD = €19450) during the DBT treatment year for the 47 DBT treatment completers, and €14750 (SD = €18592) during the follow-up year for the 33 patients who participated in the final assessment. Cost savings were mainly due to marked reductions in inpatient treatment costs, while indirect costs barely decreased. In conclusion, our findings provide evidence that the treatment of BPD patients with an outpatient DBT program is associated with substantial overall cost savings. Already during the DBT treatment year, these savings clearly exceed the additional treatment costs of DBT and are further extended during the follow-up year. Correspondingly, outpatient DBT has the potential to be a cost-effective treatment for BPD patients. Efforts promoting its implementation in routine care should be undertaken.
authors.affiliation: Department of Psychology, Humboldt-University, Unter den Linden 6, 10999 Berlin, Germany. Electronic address: till.wagner@uksh.de.
authors.forename: Till
authors.initials: T
authors.lastname: Wagner
authors.affiliation: Department of Psychology, Humboldt-University, Unter den Linden 6, 10999 Berlin, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Fydrich
authors.affiliation: Arbeitsgemeinschaft für Wissenschaftliche Psychotherapie, Witzlebenstraße 30a, 14057 Berlin, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Stiglmayr
authors.affiliation: Institute of Health Care Management, University of Greifswald, Friedrich-Loeffler-Straße 70, 17489 Greifswald, Germany.
authors.forename: Paul
authors.initials: P
authors.lastname: Marschall
authors.affiliation: Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, D6, 68159 Mannheim, Germany.
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Salize
authors.affiliation: Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany.
authors.forename: Babette
authors.initials: B
authors.lastname: Renneberg
authors.affiliation: Institute of Health Care Management, University of Greifswald, Friedrich-Loeffler-Straße 70, 17489 Greifswald, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Fleßa
authors.affiliation: Department of Psychiatry, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Eschenallee 3, 14050 Berlin, Germany. Electronic address: stefan.roepke@charite.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Roepke
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D001521:Behavior Therapy / Q000191:economics / Q000379:methods*; D001883:Borderline Personality Disorder / Q000191:economics / Q000523:psychology / Q000628:therapy*; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D004526:Efficiency; D005260:Female; D005858:Germany; D017048:Health Care Costs; D006801:Humans; D008297:Male; D016896:Treatment Outcome; D055815:Young Adult
keywords: Borderline personality disorder; Cost-effectiveness; Cost-of-illness; Cost-offset; Dialectical behavior therapy; Efficiency