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The Cost Effectiveness of Treatment of Personality Disorder

Dr. Jan J.V. Busschbach PTC De Viersprong, Erasmus MC, Rotterdam,

J.vanbusschbach@erasmusmc.nl

www.Busschbach.nl

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Cost Effectiveness

Cost Effects Cost / Effects

Intervention $ / QALY

GM-CSF in elderly with leukemia 235,958

EPO in dialysis patients 139,623

Lung transplantation 100,957

End stage renal disease management 53,513

Heart transplantation 46,775

Didronel in osteoporosis 32,047

PTA with Stent 17,889

Breast cancer screening 5,147

Viagra 5,097

Treatment of congenital anorectal malformations 2,778

QALY League table

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Rare formal CE research

Cost Effectiveness (CE) research focuses on: New pharmaceutical

• Guidelines NICE / CvZ

New high cost technical innovations

• Hip fractions

For most common interventions no data Wheel chair, home care, visits to family doctors…

Intervention in Personality Disorder are no exception

New initiatives in PD University of Maastricht

De Viersprong (UvA, Erasmus MC)

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What doe we know?

Effects can be considerable Personality Disorder can be treated successfully

Effect are generic

Cost can be high As a complex psychological intervention has to be

implemented

Savings in other area's are likely

• As with all intensive treatments..

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Effects

0.5

0.6

0.7

0.8

0.9

1.0

Intake 1 year after 2 years

EQ

-5D

soc

ial v

alue

s

Clinic 12 monthsClinic 6 monthsClinic 3 monthsOut-patient clinic

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Direct costs STIP

STIP Short-Term Inpatient Psychotherapy

Cost price Per patient day: 210.34 €

3 mouths = 91.3 day

91.3 x 210 = 19,194.53 €

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The economic burden of personality disorders

Possible savings Soeteman, et al.

Submitted to Journal of Clinical Psychiatry

Direct Medical costs before treatment

Total € 7397

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Productivity losses

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Savings

Savings might outweighed costs Gabber et al.

Review 1997, AJP

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QALY League table

Intervention $ / QALY

GM-CSF in elderly with leukemia 235,958

EPO in dialysis patients 139,623

Lung transplantation 100,957

End stage renal disease management 53,513

Heart transplantation 46,775

Didronel in osteoporosis 32,047

PTA with Stent 17,889

STIP: Short-term inpatient psychotherapy 15,000

Breast cancer screening 5,147

Viagra 5,097

Treatment of congenital anorectal malformations 2,778

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Only cost effectiveness?

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0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1

Depressieve stoornis

Pt. met nierfalen in dialyse

Reuma

Persoonlijkheidsstoornissen

Longkanker

Ziekte van Parkinson

Type II diabetes

Ambulante schizofrenie pt.(behandeld met neuroleptica)

HIV geinfecteerde pt.

Algemene populatie

EQ-5D score

Burden of disease

Soeteman et al, 2007 The burden of disease in personality disorders: diagnosis-specific quality of life. Accepted for publication in the Journal of Personality Disorder

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Conclusion

Formal cost effectiveness data is lacking Is on it way…

Costs are high Savings are likely Effects are substantial The cost effectiveness is therefore likely to be

reasonable A cost effective treatment for a disease with a considerable

burden