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The Cost Effectiveness of Treatment of Personality Disorder
Dr. Jan J.V. Busschbach PTC De Viersprong, Erasmus MC, Rotterdam,
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