title: The cost-effectiveness of short-term and long-term psychotherapy in the treatment of depressive and anxiety disorders during a 5-year follow-up.
abstract: Both short-term and long-term psychotherapies are used extensively in treating different mental disorders, but there have been practically no attempts to compare their cost-effectiveness. The aim of this study, which is part of the Helsinki Psychotherapy Study, is to assess the cost-effectiveness of two short-term therapies compared to that of a long-term therapy. In this study 326 outpatients suffering from mood or anxiety disorder were randomized to solution-focused therapy (SFT), short-term psychodynamic psychotherapy (SPP) or to long-term psychodynamic psychotherapy (LPP). Psychiatric symptoms and working ability were assessed at baseline and then 4-9 times during a 5-year follow-up using eight widely used measures including e.g. Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HDRS), Symptom Check List, anxiety scale (SCL-90-Anx), Hamilton Anxiety Rating Scale (HARS), Symptom Check List, Global Severity Index (SCL-90-GSI), and the Work-subscale (SAS-Work) of the Social Adjustment Scale (SAS-SR). Both direct and indirect costs were measured. During the 5-year follow-up period statistically significant improvements were observed in all health indicators in all therapy groups. At first the recovery was faster in the short-term therapy groups than in the LPP group, but taking the whole follow-up period into account, the effectiveness of the LPP was somewhat greater than that of the short-term therapies. Especially the direct costs were, however, much higher in the LPP group than in the short-term therapy groups. Thus the long-term therapy can hardly be regarded as cost-effective compared to short-term therapies when patients are randomized to the therapy groups.
authors.affiliation: Social Insurance Institution, P.O. Box 450, FI-00101 Helsinki, Finland. Electronic address: timo.maljanen@kela.fi.
authors.forename: Timo
authors.initials: T
authors.lastname: Maljanen
authors.affiliation: National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland; Biomedicum Helsinki, Helsinki, Finland.
authors.forename: Paul
authors.initials: P
authors.lastname: Knekt
authors.affiliation: National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland.
authors.forename: Olavi
authors.initials: O
authors.lastname: Lindfors
authors.affiliation: National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland.
authors.forename: Esa
authors.initials: E
authors.lastname: Virtala
authors.affiliation: Social Insurance Institution, P.O. Box 450, FI-00101 Helsinki, Finland.
authors.forename: Päivi
authors.initials: P
authors.lastname: Tillman
authors.affiliation: National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland.
authors.forename: Tommi
authors.initials: T
authors.lastname: Härkänen
authors.affiliation: Social Insurance Institution, P.O. Box 450, FI-00101 Helsinki, Finland; National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland; Biomedicum Helsinki, Helsinki, Finland; Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland; Rehabilitation Foundation, Helsinki, Finland.
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000191:economics / Q000628:therapy*; D017281:Cost of Illness; D003362:Cost-Benefit Analysis / Q000191:economics*; D003866:Depressive Disorder / Q000191:economics / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D011614:Psychotherapy, Brief / Q000191:economics*; D064889:Psychotherapy, Psychodynamic / Q000191:economics*
keywords: Anxiety; Cost-effectiveness; Depression; Psychotherapy