Abstract
Background/aims
This paper investigates the cost-effectiveness of dialectical behaviour therapy (DBT) for treating individuals with borderline personality disorder (BPD) in a community setting in Ireland, in the short term.
Methods
Resource utilisation and effectiveness data were collected as part of the National DBT Project, Ireland, and are incorporated into a cost-effectiveness analysis. The perspective taken was that of the service provider and payer. Direct health resources were included and effectiveness was measured using the EQ-5D-5L questionnaire. To examine cost-effectiveness, incremental costs are compared with incremental quality-adjusted life years, to estimate an incremental cost-effectiveness ratio. A probabilistic sensitivity analysis was employed to investigate parameter uncertainty. Scenario analyses are employed to investigate cost-effectiveness of DBT with varying assumptions around effectiveness and costs.
Results
The baseline analysis reveals that DBT is more expensive and more effective than routine clinical care (without DBT). The low incremental cost-effectiveness ratio suggests DBT can be considered cost effective in the short term. In each scenario analyses considered, the probability that DBT is cost effective is greater than 50%.
Conclusions
Mental health care provision, including that of DBT, varies across jurisdictions, necessitating economic evaluations of current practice in community-based services, on a country-by-country basis, to inform resource allocation decisions. In line with previous research, the analysis here indicates DBT can be considered cost effective in the short term. Future data collection on alternative comparators and long-term outcomes associated with DBT is warranted to investigate the longer term cost-effectiveness of DBT.
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References
Flynn D, Kells M, Joyce M (2017) Implementation in national systems: DBT in an Irish context. The Oxford handbook of dialectical behaviour therapy. Oxford University Press. In-press. Google Scholar, Oxford
Linehan M, Heard H (1999) Borderline personality disorder: cost, course, and treatment outcome. In: Miller N, et Magruder K (eds) Cost-effectiveness of psychotherapy. A guide for practitioners, researchers, and policy makers. Oxford University Press, Oxford
Kuo JR, Korslund KE, Linehan M (2006) The handbook of adult clinical psychology: an evidence-based practice approach, ed. C.A.M. M. Routledge, London
Flynn D et al (2018) Dialectical behaviour therapy for treating adults and adolescents with emotional and behavioural dysregulation: study protocol of a coordinated implementation in a publicly funded health service. BMC Psychiatry 18(1):51
O'Shea, E. and B. Kennelly, The economics of mental health care in Ireland. 2008
Cronin J, Bourke J (2017) Value for money? An examination of the relationship between need and cost in intellectual disability services. Health Soc Care Community 25(3):1227–1236
Evers S, Van Wijk A, Ament A (1997) Economic evaluation of mental health care interventions. A review. Health Econ 6(2):161–177
Evers S, Salvador–Carulla L, Halsteinli V, McDaid D, The Mheen Group (2007) Implementing mental health economic evaluation evidence: building a bridge between theory and practice. J Ment Health 16(2):223–241
Hoch JS, Dewa CS (2007) Lessons from trial-based cost-effectiveness analyses of mental health interventions. Pharmacoeconomics 6(2):161–177
Dept. of Health and Children (2006) A vision for change: report of the expert group on mental health policy. Stationery Office Dublin
Brettschneider C, Riedel-Heller, König H-H (2014) A systematic review of economic evaluations of treatments for borderline personality disorder. PLoS One 9:e107748
Meuldijk D, McCarthy A, Bourke ME, Grenyer BFS (2017) The value of psychological treatment for borderline personality disorder: systematic review and cost offset analysis of economic evaluations. PLoS One 12(3):e0171592
Soeteman DI, Hakkaart-van Roijen L, Verheul R, Busschbach JJV (2008) The economic burden of personality disorders in mental health care. J Clin Psychiatry 69(2):259–265
van Asselt ADI, Dirksen CD, Arntz A, Severens JL (2007) The cost of borderline personality disorder: societal cost of illness in BPD-patients. Eur Psychiatry 22(6):354–361
Salvador-Carulla L, Bendeck M, Ferrer M, Andión Ó, Aragonès E, Casas M (2014) Cost of borderline personality disorder in Catalonia (Spain). Eur Psychiatry 29(8):490–497
Knapp M et al (2011) The economic consequences of deinstitutionalisation of mental health services: lessons from a systematic review of European experience. Health Soc Care Community 19(2):113–125
HIQA (2019) Guidelines for the Economic Evaluation of Health Technologies in Ireland 2019. Health Information and Quality Authority: Dublin, Ireland
Larg A, Moss JR (2011) Cost-of-illness studies. Pharmacoeconomics 29(8):653–671
Drummond MF et al (2015) Methods for the economic evaluation of health care programmes. Oxford university press
Raftery M, Burke K, Murray N, O’Duinn O, Murray I, Hallahan B (2017) An intensive personalised support approach to treating individuals with psychosis and co-morbid mild intellectual disability. Ir J Psychol Med 34(2):99–109
Bourke J, Murphy A, Flynn D, Kells M, Joyce M, Hurley J (2018) Borderline personality disorder: resource utilisation costs in Ireland. Ir J Psychol Med 1–8
HSE (2013) Ready reckoner of acute hospital inpatient and daycase activity and cost (summarised by DRG) relating to 2011 costs and activity. In: National casemix programme, H.S. Executive, Editor
Gannon B, O’Shea E, Hudson E (2007) The economic costs of falls and fractures in people aged 65 and over in Ireland. in Technical report to NCAOP/HSE/DOHC. Irish Centre for Social Gerontology: Galway
Dept. of Health (2018) In: Department of Health (ed) Department of Health Consolidated Salary Scales, Dublin, Ireland
PCRS. Welcome to Primary Care Reimbursement Service - HSE.ie. 2017 [cited 2017 1/9/2017]; Available from: http://www.hse.ie/eng/staff/PCRS/
Pharmacoeconomics, N.C.f. Guidelines for inclusion of drug costs in pharmacoeconomic evaluations. 2016 [cited 2017 17th January 2017]; Available from: (http://www.ncpe.ie/wp-content/uploads/2016/09/Final-Guidelines-for-Inclusion-of-Drug-Costs-in-Pharmacoeconomic
Herdman M, Gudex C, Lloyd A, Janssen MF, Kind P, Parkin D, Bonsel G, Badia X (2011) Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res 20(10):1727–1736
Hobbins A, Barry L, Kelleher D, Shah K, Devlin N, Goni JMR, O’Neill C (2018) Utility values for health states in Ireland: a value set for the EQ-5D-5L. PharmacoEconomics 36(11):1345–1353
Fenwick E, Claxton K, Sculpher M (2001) Representing uncertainty: the role of cost-effectiveness acceptability curves. Health Econ 10(8):779–787
Fenwick E, O'Brien BJ, Briggs A (2004) Cost-effectiveness acceptability curves–facts, fallacies and frequently asked questions. Health Econ 13(5):405–415
O’Brien BBA (2002) Analysis of uncertainty in health care cost-effectiveness studies: an introduction to statistical issues and methods. Stat Methods Med Res 11(6):455–468
Feliu-Soler A et al Economic impact of third-wave cognitive behavioral therapies: a systematic review and quality assessment of economic evaluations in randomized controlled trials. Behav Ther 2017
Priebe S, Bhatti N, Barnicot K, Bremner S, Gaglia A, Katsakou C, Molosankwe I, McCrone P, Zinkler M (2012) Effectiveness and cost-effectiveness of dialectical behaviour therapy for self-harming patients with personality disorder: a pragmatic randomised controlled trial. Psychother Psychosom 81(6):356–365
Linehan MM, Suarez A, Allmon D (1991) Cognitive-behavioral treatment of chronically. Arch Gen Psychiatry 48:1060–1064
Heard HL (2000) Cost-effectiveness of dialectical behavior therapy in the treatment of borderline personality disorder. ProQuest Information & Learning, US, pp 3278–3278
van den Bosch LMC et al (2014) Efficacy and cost-effectiveness of an experimental short-term inpatient Dialectical Behavior Therapy (DBT) program: study protocol for a randomized controlled trial. Trials 15(1):152–152 1p
Koons CR, Robins CJ, Lindsey Tweed J, Lynch TR, Gonzalez AM, Morse JQ, Bishop GK, Butterfield MI, Bastian LA (2001) Efficacy of dialectical behavior therapy in women veterans with borderline personality disorder. Behav Ther 32(2):371–390
Pasieczny N, Connor J (2011) The effectiveness of dialectical behaviour therapy in routine public mental health settings: an Australian controlled trial. Behav Res Ther 49(1):4–10
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Murphy, A., Bourke, J., Flynn, D. et al. A cost-effectiveness analysis of dialectical behaviour therapy for treating individuals with borderline personality disorder in the community. Ir J Med Sci 189, 415–423 (2020). https://doi.org/10.1007/s11845-019-02091-8
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DOI: https://doi.org/10.1007/s11845-019-02091-8