Abstract
Background
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.
Methods
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.
Results
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.
Conclusions
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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References
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)
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)
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)
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)
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)
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). http://www.bptk.de (2015). Accessed 17 Feb 2016
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)
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)
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)
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)
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)
Paris, J.: Implications of long-term outcome research for the management of patients with borderline personality disorder. Harvard Rev. Psychiatry 10, 315–323 (2002)
Lieb, K., Zanarini, M.C., Schmahl, C., Linehan, M.M., Bohus, M.: Borderline personality disorder. Lancet 364(9432), 453–461 (2004)
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)
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)
Torgersen, S., Kringlen, E., Cramer, V.: The prevalence of personality disorders in a community sample. Arch. Gen. Psychiatry 58(6), 590–596 (2001)
Zimmerman, M., Rothschild, L., Chelminski, I.: The prevalence of DSM-IV personality disorders in psychiatric outpatients. Am. J. Psychiatry 162(10), 1911–1918 (2005)
Widiger, T.A., Weissman, M.M.: Epidemiology of borderline personality disorder. Hosp. Community Psychiatry 42(10), 1015–1021 (1991)
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)
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)
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)
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. http://www.hindawi.com/journals/drt/2014/730891/ (2014). Accessed 17 Feb 2016
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)
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)
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)
Andersohn, F., Walker, J.: Characteristics and external validity of the German Health Risk Institute (HRI) Database. Pharmacoepidem. Drug S. 25, 106–109 (2016)
Graubner, B.: ICD-10-GM 2012 (Vol. 2). Deutscher Ärzteverlag, Köln (2011)
Bundesvereinigung, Kassenärztliche: Einheitlicher Bewertungsmaßstab Psychotherapie (Physician’s fee schedule for psychotherapy). Kassenärztliche Bundesvereinigung, Berlin (2013)
Institut für das Entgeld im Krankenhaus: G-DRG-System (German diagnosis related groups-system). http://www.g-drg.de (2013). Accessed 8 Oct 2015
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)
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)
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)
Leichsenring, F., Leibing, E., Kruse, J., New, A.S., Leweke, F.: Borderline personality disorder. Lancet 377(9759), 74–84 (2011)
National Institute for Health and Clinical Excellence: Depression: the treatment and management of depression in adults. http://www.nice.org.uk (2010). Accessed 17 Feb 2016
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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). https://doi.org/10.1007/s10198-016-0858-2
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DOI: https://doi.org/10.1007/s10198-016-0858-2
Keywords
- Borderline personality disorder
- Major depressive disorder
- Health care service utilization
- Costs of illness
- Claims data