1. 1 The Cost Effectiveness of Treatment of Personality Disorder  Dr. Jan J.V. Busschbach  PTC De Viersprong, Erasmus MC, Rotterdam,  J.vanbusschbach@erasmusmc.nl  www.Busschbach.nl www.Busschbach.nl

2. 2 Cost Effectiveness  Cost  Effects  Cost / Effects QALY League table

3. 3 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)

4. 4 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..

5. 5 Effects

6. 6 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 €

7. 7 The economic burden of personality disorders  Possible savings  Soeteman, et al.  Submitted to Journal of Clinical Psychiatry  Direct Medical costs before treatment  Total € 7397

8. 8 Productivity losses

9. 9 Savings  Savings might outweighed costs  Gabber et al.  Review 1997, AJP

10. 10 QALY League table

11. 11 Only cost effectiveness?

12. 12 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

13. 13 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