title: Cost of borderline personality disorder in Catalonia (Spain).
abstract: BACKGROUND
  The available information on the cost of illness of Borderline Personality Disorder (BPD) is overtly insufficient for policy planning. Our aim was to estimate the costs of illness for BPD in Catalonia (Spain) for 2006.
  
  
  METHODS
  This is a multilevel cross-design synthesis study combining a qualitative nominal approach, quantitative 'top-down' analysis of multiple health databases, and 'bottom-up' data of local surveys. Both direct and indirect costs have been estimated from a governmental and societal perspective.
  
  
  RESULTS
  Estimated year-prevalence of BPD was 0.7% (41,921 cases), but only 9.6% of these cases were treated in the mental health system (4033 cases). The baseline of the total cost of BPD in Catalonia was 45.6 million€, of which 15.8 million€ (34.7%) were direct costs related to mental health care. The cost distribution was 0.4% in primary care; 4% in outpatient mental health care; 4.7% in hospitalisation; 0.7% in emergency care; and 24.9% in pharmacotherapy. Additionally, the cost of drug addiction treatment for persons with BPD was 11.2%; costs associated with sheltered employment were 23.9% and those of crime and justice were 9.7%. Indirect costs - including temporary sick leave and premature death (suicide) - represented 20.5% of total costs. The average annual cost per patient was 11,308€.
  
  
  CONCLUSIONS
  An under-reporting of BPD was identified by the experts in all health databases and official registries. Most of the BPD costs were not related to mental health care. Amongst the direct cost categories, pharmacotherapy had the largest proportion despite the lack of specificity for BPD. This distribution of costs reinforces the idea of BPD complexity related to an inadequate and inefficient use of health resources.
authors.affiliation: Centre for Disability Research and Policy, Faculty of Health Sciences, Unit of Mental Health Policy, Brain and Mind Research Institute, The University of Sydney, Sydney, Australia. Electronic address: luis.salvador-carulla@sydney.edu.au.
authors.forename: L
authors.initials: L
authors.lastname: Salvador-Carulla
authors.affiliation: InGenis Consulting Group, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Bendeck
authors.affiliation: Psychiatry Department, Hospital Universitari Vall d'Hebron, CIBERSAM, Barcelona, Spain; Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Ferrer
authors.affiliation: Psychiatry Department, Hospital Universitari Vall d'Hebron, CIBERSAM, Barcelona, Spain; Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain; Institut de Neurociències, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: O
authors.initials: O
authors.lastname: Andión
authors.affiliation: Centre d'Atenció Primària de Constantí, Institut Català de la Salut, Catalonia, Spain, and Institut d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Aragonès
authors.affiliation: Psychiatry Department, Hospital Universitari Vall d'Hebron, CIBERSAM, Barcelona, Spain; Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Casas
mesh_terms: D000293:Adolescent; D000328:Adult; D001883:Borderline Personality Disorder / Q000191:economics* / Q000453:epidemiology; D003156:Community Mental Health Services / Q000191:economics; D017281:Cost of Illness; D016527:Drug Costs / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000191:economics; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006778:Hospitals, Psychiatric / Q000191:economics; D006801:Humans; D008297:Male; D015995:Prevalence; D013030:Spain / Q000453:epidemiology; D055815:Young Adult
keywords: Borderline personality disorder; Cost of illness; Health economics; Qualitative research; Quantitative analysis