Cost-Effectiveness of Psychotherapy for Cluster C Personality Disorders

This article, published in the Journal of Clinical Psychiatry, describes a probabilistic Markov cohort model that compares the cost-effectiveness of five treatment modalities (long-term outpatient psychotherapy, short-term and long-term day hospital psychotherapy, and short-term and long-term inpatient psychotherapy) for patients with cluster C personality disorders. The analyses are conducted from the societal and payer perspectives. Patient-level data comes from 466 patients with cluster C personality disorders who were admitted to 6 specialist centers of psychotherapy in The Netherlands.

The cost-effectiveness results over a 5-year time horizon show that the long-term psychotherapies (outpatient, day hospital and inpatient) all strongly dominated. The incremental cost-effectiveness ratio comparing short-term inpatient psychotherapy with short-term day hospital psychotherapy is €16,570 (US $21,062.29) per QALY from the societal perspective and €66,302 (US $84,277.13) per QALY from the payer perspective.

Based on these findings the authors conclude that both short-term day hospital psychotherapy and short-term inpatient psychotherapy can be considered cost-effective therapy choices. If the burden of disease is taken into account in determining a cost-effectiveness threshold (in that case the threshold will be at €37,600 per QALY), short-term inpatient psychotherapy is the optimal treatment choice.