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Out-patient psychotherapy for borderline personality disorder: cost-effectiveness of schema-focused therapy v. transference-focused psychotherapy

Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, Maastricht

Arnoud Arntz

Department of Medical, Clinical and Experimental Psychology, Maastricht University

Josephine H. Giesen-Bloo

Department of Medical, Clinical and Experimental Psychology, Maastricht University, and Department of Medical Psychology, University Hospital Maastricht, Maastricht

Richard van Dyck

Department of Psychiatry, VU Medical Center/GGZ BuitenAmstel, Amsterdam

Philip Spinhoven

Department of Clinical and Health Psychology and Department of Psychiatry, Leiden University, Leiden

Willem van Tilburg

Department of Psychiatry, VU Medical Center/GGZ BuitenAmstel, Amsterdam

Ismay P. Kremers

Department of Clinical and Health Psychology and Department of Psychiatry, Leiden University, Leiden

Marjon Nadort

Department of Psychiatry, VU Medical Center/GGZ BuitenAmstel, Amsterdam

Johan L. Severens

Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, and Department of Health Organisation, Policy and Economics, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands

Correspondence: Thea van Asselt, University Hospital Maastricht, Department KEMTA, PO Box 5800, 6202 AZ Maastricht, The Netherlands. Email: avas{at}kemta.azm.nl

Declaration of interest

None. Funding detailed in Acknowledgements.

Background

Schema-focused therapy (SFT) and transference-focused psychotherapy (TFP) for borderline personality disorder were recently compared in a randomised multicentre trial.

Aims

To assess the societal cost-effectiveness of SFT v. TFP in treating borderline personality disorder.

Method

Costs were assessed by interview. Health-related quality of life was measured using EQ–5D. Outcomes were costs per recovered patient (recovery assessed with the Borderline Personality Disorder Severity Index) and costs per quality-adjusted life-year (QALY).

Results

Mean 4-year bootstrapped costs were 37 826 for SFT and 46 795 for TFP (95% uncertainty interval for difference –21 775 to 3546); QALYs were 2.15 for SFT and 2.27 for TFP (95% UI –0.51 to 0.28). The percentages of patients who recovered were 52% and 29% respectively. The SFT intervention was less costly and more effective than TFP (dominant), for recovery; it saved 90 457 for one QALY loss.

Conclusions

Despite the initial slight disadvantage in QALYs, there is a high probability that compared with TFP, SFT is a cost-effective treatment for borderline personality disorder.

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Highlights of this issue

Kimberlie Dean
BJP 2008 192: A22. [Full Text]