Health care costs of borderline personality disorder and matched controls with major depressive disorder: a comparative study based on anonymized claims data



Borderline personality disorder (BPD) and major depressive disorder (MDD) pose a significant burden to the German health care system in terms of direct and indirect costs. The aim of this study was to determine the incremental costs that arise due to the treatment of patients with BPD, in relation to MDD patients adjusted for gender and age.


Insured persons who suffered from BPD (F60.3; N = 6599) or MDD (F32, F33; N = 26,396) in the year 2010 were identified from the German Health Risk Institute research database. To estimate the costs resulting from disorder-specific health care service utilization and the mean total costs per patient for the health care system, we analyzed anonymized claims data of individuals with BPD and matched individuals with MDD.


The costs resulting from disorder-specific health care service utilization 1 year after index diagnosis amounted to 8508 EUR for BPD and 8281 EUR for MDD per patient utilizing services. With mean total annual costs per patient of 4636 EUR versus 2020 EUR 1 year preceding index diagnosis, 7478 EUR versus 3638 EUR in the year after index diagnosis, and 11,817 EUR versus 6058 EUR 2 years after index diagnosis, BPD patients incurred markedly higher costs.


Since the treatment of BPD causes incremental costs for the German health care system compared to the treatment of MDD, and since both conditions are associated with a high level of suffering, there is a need for establishing adequate and early treatment of these mental disorders.

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  1. 1.

    Alonso, J., Angermeyer, M.C., Bernert, S., Bruffaerts, R., Brugha, T.S., Bryson, H., et al.: Use of mental health services in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr. Scand. 109, 47–54 (2004)

    Article  Google Scholar 

  2. 2.

    Wittchen, H.U., Jacobi, F., Rehm, J., Gustavsson, A., Svensson, M., Jönsson, B., et al.: The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur. Neuropsychopharmacol. 21, 655–679 (2011)

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Kessler, R.C., Aguilar-Gaxiola, S., Alonso, J., Chatterji, S., Lee, S., Ormel, J., et al.: The global burden of mental disorders: an update from the WHO World Mental Health (WMH) surveys. Epidemiol. Psichiatr. Soc. 18(1), 23–33 (2009)

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Alonso, J., Angermeyer, M.C., Bernert, S., Bruffaerts, R., Brugha, T.S., Bryson, H., et al.: Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr. Scand. 109, 21–27 (2004)

    Article  Google Scholar 

  5. 5.

    Murray, C.J.L., Lopez, A.D.: Global mortality, disability and the contribution of risk factors: global burden of disease study. Lancet 9063, 1436–1442 (1997)

    Article  Google Scholar 

  6. 6.

    Bundespsychotherapeutenkammer: BPtK-Studie zur Arbeitsunfähigkeit 2015. Psychische Erkrankungen und Krankengeldmanagement (Study of the German Federal Psychotherapists Chamber concerning incapacity to work 2015. Mental disorders and management of sickness benefit payments). (2015). Accessed 17 Feb 2016

  7. 7.

    Bender, D.S., Skodol, A.E., Pagano, M.E., Dyck, I.R., Grilo, C.M., Shea, M.T., et al.: Prospective assessment of treatment use by patients with personality disorders. Psychiatr. Serv. 7(2), 254–257 (2006)

    Article  Google Scholar 

  8. 8.

    Soeteman, D.I., Roijen, L.H.V., Verheul, R., Busschbach, J.J.: The economic burden of personality disorders in mental health care. J. Clin. Psychiatry 69(2), 259–265 (2008)

    Article  PubMed  Google Scholar 

  9. 9.

    Van Asselt, A.D.I., Dirksen, C.D., Arntz, A., Severens, J.L.: The cost of borderline personality disorder: societal cost of illness in BPS-patients. Eur. Psychiatry 22(6), 354–361 (2008)

    Article  Google Scholar 

  10. 10.

    Black, D.W., Blum, N., Prohl, B., Hale, N.: Suicidal behavior in borderline personality disorder: prevalence, risk factors, prediction, and prevention. J. Pers. Disord. 18, 226–239 (2004)

    Article  PubMed  Google Scholar 

  11. 11.

    Linehan, M.M., Heard, H.L.: Borderline personality disorder: costs, course, and treatment outcomes. In: Miller, N., Magruder, K. (eds.) The cost effectiveness of psychotherapy: a guide for practitioners, researchers and policy-makers, pp. 215–224. Oxford University Press, Oxford (1999)

    Google Scholar 

  12. 12.

    Paris, J.: Implications of long-term outcome research for the management of patients with borderline personality disorder. Harvard Rev. Psychiatry 10, 315–323 (2002)

    Article  Google Scholar 

  13. 13.

    Lieb, K., Zanarini, M.C., Schmahl, C., Linehan, M.M., Bohus, M.: Borderline personality disorder. Lancet 364(9432), 453–461 (2004)

    Article  PubMed  Google Scholar 

  14. 14.

    Grant, B.F., Chou, S.P., Goldstein, R.B., Huang, B., Stinson, F.S., Saha, T.D., et al.: Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on alcohol and related conditions. J. Clin. Psychiatry 69(4), 533–545 (2008)

    Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Swartz, M., Blazer, D., George, L., Winfield, I.: Estimating the prevalence of borderline personality disorder in the community. J. Pers. Disord. 4(3), 257–272 (1990)

    Article  Google Scholar 

  16. 16.

    Torgersen, S., Kringlen, E., Cramer, V.: The prevalence of personality disorders in a community sample. Arch. Gen. Psychiatry 58(6), 590–596 (2001)

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Zimmerman, M., Rothschild, L., Chelminski, I.: The prevalence of DSM-IV personality disorders in psychiatric outpatients. Am. J. Psychiatry 162(10), 1911–1918 (2005)

    Article  PubMed  Google Scholar 

  18. 18.

    Widiger, T.A., Weissman, M.M.: Epidemiology of borderline personality disorder. Hosp. Community Psychiatry 42(10), 1015–1021 (1991)

    CAS  PubMed  Google Scholar 

  19. 19.

    Luppa, M., Heinrich, S., Angermeyer, M.C., König, H.H., Riedel-Heller, S.G.: Cost-of-illness studies of depression: a systematic review. J. Affect. Disord. 98(1–2), 29–43 (2007)

    Article  PubMed  Google Scholar 

  20. 20.

    Bock, J.O., Luppa, M., Brettschneider, C., Riedel-Heller, S., Bickel, H., Fuchs, A.: Impact of depression on health care utilization and costs among multimorbid patients—results from the multicare cohort study. PLoS One 9(3), e91973 (2014)

    Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Kleine-Budde, K., Müller, R., Kawohl, W., Bramesfeld, A., Moock, J., Rössler, W.: The cost of depression—a cost analysis from a large database. J. Affect. Disord. 147(1), 137–143 (2013)

    Article  PubMed  Google Scholar 

  22. 22.

    Krauth, C., Stahmeyer, J.T., Petersen, J.J., Freytag, A., Gerlach, F.M., Gensichen, J.: Resource utilisation and costs of depressive patients in Germany: results from the primary care monitoring for depressive patients trial. (2014). Accessed 17 Feb 2016

  23. 23.

    Bateman, A., Fonagy, P.: Health service utilization costs for borderline personality disorder patients treated with psychoanalytically oriented partial hospitalization versus general psychiatric care. Am. J. Psychiatry 160, 169–171 (2003)

    Article  PubMed  Google Scholar 

  24. 24.

    Van Asselt, A.D.I., Dirksen, C.D., Arntz, A., Giesen-Bloo, J.H., van Dyck, R., Spinhoven, P., et al.: Out-patient psychotherapy for borderline personality disorder: cost-effectiveness of schema-focused therapy v. transference-focused psychotherapy. Brit. J. Psychiatry 192(6), 450–457 (2008)

    Article  Google Scholar 

  25. 25.

    Wunsch, E.M., Kliem, S., Kröger, C.: Population-based cost-offset estimation for the treatment of borderline personality disorder: projected costs in a currently running, ideal health system. Behav. Res. Ther. 60, 1–7 (2014)

    Article  PubMed  Google Scholar 

  26. 26.

    Andersohn, F., Walker, J.: Characteristics and external validity of the German Health Risk Institute (HRI) Database. Pharmacoepidem. Drug S. 25, 106–109 (2016)

    Article  Google Scholar 

  27. 27.

    Graubner, B.: ICD-10-GM 2012 (Vol. 2). Deutscher Ärzteverlag, Köln (2011)

  28. 28.

    Bundesvereinigung, Kassenärztliche: Einheitlicher Bewertungsmaßstab Psychotherapie (Physician’s fee schedule for psychotherapy). Kassenärztliche Bundesvereinigung, Berlin (2013)

    Google Scholar 

  29. 29.

    Institut für das Entgeld im Krankenhaus: G-DRG-System (German diagnosis related groups-system). (2013). Accessed 8 Oct 2015

  30. 30.

    Gustavsson, A., Svensson, M., Jacobi, F., Allgulander, C., Alonso, J., Beghi, E., et al.: Cost of disorders of the brain in Europe 2010. Eur. Neuropsychopharmcol. 21(10), 718–779 (2011)

    CAS  Article  Google Scholar 

  31. 31.

    Wagner, T., Fydrich, T., Stiglmayr, C., Marschall, P., Salize, H.J., Renneberg, B., et al.: Societal cost-of-illness in patients with borderline personality disorder one year before, during and after dialectical behavior therapy in routine outpatient care. Behav. Res. Ther. 61, 12–22 (2014)

    Article  PubMed  Google Scholar 

  32. 32.

    West, S.G., Cham, H., Thoemmes, F., Renneberg, B., Schulze, J., Weiler, M.: Propensity scores as a basis for equating groups: basic principles and application in clinical treatment outcome research. J. Consult. Clin. Psychol. 82(5), 906–919 (2014)

    Article  PubMed  Google Scholar 

  33. 33.

    Leichsenring, F., Leibing, E., Kruse, J., New, A.S., Leweke, F.: Borderline personality disorder. Lancet 377(9759), 74–84 (2011)

    Article  PubMed  Google Scholar 

  34. 34.

    National Institute for Health and Clinical Excellence: Depression: the treatment and management of depression in adults. (2010). Accessed 17 Feb 2016

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Correspondence to Katharina Bode.

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Bode, K., Vogel, R., Walker, J. et al. Health care costs of borderline personality disorder and matched controls with major depressive disorder: a comparative study based on anonymized claims data. Eur J Health Econ 18, 1125–1135 (2017).

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  • Borderline personality disorder
  • Major depressive disorder
  • Health care service utilization
  • Costs of illness
  • Claims data

JEL Classification

  • I13
  • I18