An Economic Analysis of Psychotherapy for Borderline Personality Disorder Patients

BACKGROUND: BPD is a serious mental illness in which psychotherapy has been shown to improve patient outcomes and reduce the use of health services. In most studies of psychotherapy, lower use of health services has been taken to imply lower health service costs. However, the costs of psychotherapy can offset any cost savings due to reduced use of other health services. AIMS OF THE STUDY: To estimate the net costs of health service use in a group of BPD patients receiving intensive psychotherapy. METHODS: Data on use of inpatient hospital, emergency hospital, ambulatory care, diagnostic tests and medications were collected for the twelve months before psychotherapy and the twelve months after the completion of treatment. Cost estimates were developed using standardised unit costs. RESULTS: There was a saving of approximately $670,000 in health service use over the thirty patients compared to a cost of $130,000 for psychotherapy, giving a net cost saving of $18,000 per patient. Most of this was due to reduced hospital admissions. Cost saving was higher in those patients who were high users of hospital services. Sensitivity analyses were performed; overall, the findings consistently show a reduction in the cost of health services used. DISCUSSION: The group studied consisted of 30 patients and comprised a before/after design. Therefore it does not overcome criticisms of other work in this area, that is of observational studies and small sample sizes. Nonetheless, the results were based on detailed costing of service use, using conservative assumptions and subject to sensitivity analysis. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: The use of intensive psychotherapy in BPD patients who are high users of health services, particularly those who have had multiple hospital admissions, is probably warranted until more evidence is available. IMPLICATIONS FOR HEALTH POLICIES: There is little rigorous evidence on the effectiveness and cost-effectiveness of psychotherapy. BPD patients appear to generate high service costs so it is important to establish effective and cost-effective modes of treatment. IMPLICATIONS FOR FURTHER RESEARCH: Further research is warranted to establish accurate patterns of service use in BPD patients, and to identify those groups who will most benefit from intensive psychotherapy. erans.