Health Service Utilization Costs for Borderline ... - PsychiatryOnline

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borderline personality disorder compared with treatment as usual within general psychiatric services. Method: Health care utilization of all borderline personality.
BRIEF REPORTS

Studies assessing different doses of E-EPA for longer periods of time in larger samples are needed. Received April 3, 2002; revision received Aug. 8, 2002; accepted Sept. 5, 2002. From the Laboratory for the Study of Adult Development, McLean Hospital; and the Department of Psychiatry, Harvard Medical School, Boston. Address reprint requests to Dr. Zanarini, McLean Hospital, 115 Mill St., Belmont, MA 02478; zanarini@ mclean.harvard.edu (e-mail). Supported by an Independent Investigator Award from the National Alliance for Research on Schizophrenia and Depression to Dr. Zanarini.

References 1. American Psychiatric Association: Practice Guideline for the Treatment of Patients With Borderline Personality Disorder. Am J Psychiatry 2001; 158(Oct suppl) 2. Hibbeln JR, Salem N: Omega-3 fatty acids and psychiatric disorders: current status of the field, in Fatty Acids: Physiological and Behavioral Functions. Edited by Mostofsky D, Yehuda S, Salem N. Totowa, NJ, Humana Press, 2001, pp 311–330

3. Stoll AL, Severus WE, Freeman MP, Rueter S, Zboyan HA, Diamond E, Cress KK, Marangell LB: Omega 3 fatty acids in bipolar disorder: a preliminary double-blind, placebo-controlled trial. Arch Gen Psychiatry 1999; 56:407–412 4. Nemets B, Stahl Z, Belmaker RH: Addition of omega-3 fatty acid to maintenance medication treatment for recurrent unipolar depressive disorder. Am J Psychiatry 2002; 159:477–479 5. Zanarini MC, Frankenburg FR, Chauncey DL, Gunderson JG: The Diagnostic Interview for Personality Disorders: interrater and test-retest reliability. Compr Psychiatry 1987; 28:467–480 6. Spitzer RL, Williams JBW, Gibbon M, First MB: The Structured Clinical Interview for DSM-III-R (SCID), I: history, rationale, and description. Arch Gen Psychiatry 1992; 49:624–629 7. Zanarini MC, Gunderson JG, Frankenburg FR, Chauncey DL: The Revised Diagnostic Interview for Borderlines: discriminating BPD from other axis II disorders. J Personal Disord 1989; 3: 10–18 8. Coccaro EF, Harvey PD, Kupsaw-Lawrence E, Herbert JL, Bernstein DP: Development of neuropharmacologically based behavioral assessments of impulsive aggressive behavior. J Neuropsychiatry Clin Neurosci 1991; 3(suppl):S44–51 9. Montgomery SA, Åsberg M: A new depression scale designed to be sensitive to change. Br J Psychiatry 1979; 134:382–389

Brief Report

Health Service Utilization Costs for Borderline Personality Disorder Patients Treated With Psychoanalytically Oriented Partial Hospitalization Versus General Psychiatric Care Anthony Bateman, M.A., F.R.C.Psych. Peter Fonagy, Ph.D., F.B.A.

ers. Costs were compared for the 6 months before treatment, 18 months of treatment, and an 18-month follow-up period.

Objective: The authors assessed health care costs associated with psychoanalytically oriented partial hospital treatment for borderline personality disorder compared with treatment as usual within general psychiatric services.

Results: There were no cost differences between the groups during pretreatment or treatment. Costs of partial hospital treatment were offset by less psychiatric inpatient care and reduced emergency room treatment. The trend for costs to decrease in the partial hospitalization group during the follow-up period was not apparent in the treatment-as-usual group.

Method: Health care utilization of all borderline personality disorder patients who participated in a previous trial of partial hospital treatment compared with treatment as usual was assessed by using information from case notes and service provid-

Conclusions: Specialist partial hospital treatment for borderline personality disorder is no more expensive than treatment as usual and shows considerable cost savings after treatment. (Am J Psychiatry 2003; 160:169–171)

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atients with borderline personality disorder place a high demand on health and social services (1). In our recent randomized controlled trial comparing partial hospital treatment of borderline personality disorder with treatment as usual, we found a favorable outcome on symptomatic and clinical measures for the partial hospital treatment group both at the end of treatment (2) and after 18 months of follow up (3). This article reports a cost analysis of the data from the trial, focusing on the direct costs Am J Psychiatry 160:1, January 2003

of partial hospital treatment compared with treatment as usual and on subsequent use of services over 18 months for all patients.

Method The design of the study, the sample characteristics and criteria used for borderline personality disorder, and the written informed consent obtained after explanation of the procedure have been detailed in an earlier publication (2). For this report, inforhttp://ajp.psychiatryonline.org

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BRIEF REPORTS TABLE 1. Estimated Annual Health Care Utilization Costs for Borderline Personality Disorder Patients Receiving Either Psychoanalytically Oriented Partial Hospitalization (N=22) or General Psychiatric Care (N=19) 6 Months Before Treatment

18 Months of Treatment

Cost (U.S. dollars) Partial Hospitalization Group Service Psychiatric care Inpatient Outpatient Partial hospital Medication Antidepressant Antipsychotic Minor tranquilizer Mood stabilizer Community support Emergency room Total costa

Cost (U.S. dollars)

General Care Group

Mean 39,465 24,252 1,865 13,347 844 152 679 9 3

SD Mean 23,745 47,428 22,116 27,749 1,292 1,954 10,638 17,724 442 797 75 137 391 649 10 6 10 5

SD 24,097 21,707 1,358 12,783 457 90 397 9 12

4,658 44,967

3,760 4,338 23,826 52,563

3,892 25,043

Analysis MannWhitney U z Score 183.0 –1.2 184.0 –0.7 197.0 –0.3 166.5 –1.1 189.0 –0.5 193.5 –0.4 198.5 –0.3 170.0 –1.1 195.5 –0.6 202.0 162.0

–0.2 –1.2

Partial Hospitalization Group

General Care Group

Analysis

Mean 26,204 2,344 148 23,712 288 56 231 1 1

SD Mean 7,720 26,661 2,897 7,948 401 1,992 8,659 16,721 286 797 55 140 269 637 1 11 4 10

SD 12,598 4,317 856 12,298 406 97 361 18 16

MannWhitney U 5.0 71.0 11.0 124.0 59.0 110.0 81.0 112.0 127.0

810 27,303

1,097 3,518 7,777 30,976

2,766 12,755

80.5 180.0

z Score –0.2 –3.6*** –5.5*** 2.3* –3.9*** –2.6** –3.4*** –2.7** –2.7** –3.4*** –0.8

a

Excludes cost of community support. *p