Cost-Effectiveness analysis on Transference Focused Psychotherapy and Schema-focused Therapy

1. Cost-Effectiveness analysis on Transference Focused Psychotherapy and Schema-focused Therapy Ute Linnenkamp Josefin Mattsson Qing Fang Amélie Keller

2. Table of content • Background • Aims • Methodology • Results • Discussion • Conclusion

3. Mental Health • 13 % of the global burden of disease (2004) • Increasing! • Large treatment gap: 76-85 % in low- and middle income countries 35-50 % in high income countries • 10-20 % of these Borderline Personality Disorder

4. Borderline Personality Disorder (BPD) • Disturbance of personality and self image • Variability and depth of mood - "black and white" thinking • Chaotic and unstable interpersonal relationships If untreated: risk for suicide (10% die due to suicide) Prevalence general population: 2 % (10-20% among mental disorders) Prevalence in Netherlands year 2000: 1.1 % (pop over 20 years) Why Netherlands?

5. Treatments for BPD • Bring structurally change in patients personality • Address underlying deficits in the ability of patients to relate to others and manage emotions, longstanding problems that are typically rooted in childhood experience • Example of treatments are: Cognitive Therapy (includes Dialectical Behavior Therapy, STEPPS Group Treatment), Integrated Psychotherapy (includes Metallization-Based Treatment, Schema Focused Therapy), Short-Term Dynamic Psychotherapy, Supportive Therapy, Transference Focused Psychotherapy.

6. Transference Focused Psychotherapy (TFP) • Psychodynamically based psychotherapy • Designed especially for BPD patients • Focus on the assessment and contact between therapist and patient • Well established treatment

7. Schema-focusedtherapy (SFP) • New treatment • Integrative psychotherapy – combining existing therapies • Replace maladaptive schemes to more healthy schemes • Offers more support to patients through outside office hours availability through phone calls and support when they are in crisis or emotional need • This in order for the patient to stop feeling that no one cares outside therapy sessions

8. Aims and Justification • evaluate if the delivery of Schema-focused Therapy (SFT), compared with Transference Focused Psychotherapy (TFP) is preferable in terms of costsand utilities from the viewpoint of the society

9. Methodology

10. 0.29 0.9 Pathway 1 0.1 0.71 Pathway 2 Pathway 3 Pathway 4 0.52 0.48 Pathway 5 0.55 0.45 Pathway 6 Time horizon 4 years

11. Therapy related costs for the 2 different Theapys In case of a relaps ( pathways 2 and 5) or no recovery (pathway 3 and 6) hospital costs vor A&E as well as psychiatric hospitals have been added

12. Utility ICER

13. Total Treatment costs

14. 8920.75 € 11734.70 € 31501.30 € 14907.30 € 19413.0 € 30599.73 €

15. Discussion SFT seems to be moreefficient Efficiencymight increase if time frameextended Moreexpensive ICER is over the treshholdvalue of 20.000 pounds per gained QALY

16. Conclusion • SFT is moreefficient • Costsfor one extra QALY = tooexpensive • TFP ispreferable • Depends on whatfactors and costsaretakenintoaccount!

17. References • Lieb, K., Zanarini, M.C., Schmahl, C., Linehan, M., Bohus, M. (2004) Borderline Personality Disorder. The Lancet. 364 (9432): 453-461 • Paris, J. (2005) Borderline Personality Disorder. CMAJ. 172 (12): 1579-1583 • WHO (2012) Mental health. [online] available at: http://www.who.int/mental_health/WHA65.4_resolution.pdf [Accessed 9/6-2012] • Antoinette D., van Asselt, Dirksen C.D, Arntz A., Giesen- Bloo J.H., van Dyck R., Spinhoven P., van Tilburg W., Kremers I.P., Nadort M., Severens J.L., (2008) Out- patient psychotherapy for borderline personality disorder: cost-effectiveness of schame-focused therapy v. transference-focused psychotherapy, The British Journal of Psychiatry 197, 450-457 • A., C. (sd). Short-Term Psychotheraphy, A Psychodynamic Approach, Assessment and the borderline personality. 130-131. • Drummond, M. F., Sculpher, M. J., Torrance, G. W., O'Brien, B. J., & Stoddart, G. L. (2005). Methods for the Economic Evaluation of Health Care Programms Third Edition. Oxford: Oxford University Press. • Fox-Rushby J., Cairns J.,(2005), Economic Evaluation, Open University Press, Basic Sensitivity Analysis, 162-163 • Oostenbrink, J., Bouwmans, C., Koopmanschap, M., & Rutten, F. (2004). Handleiding voor kostenonderzoek ; Methoden en standaard kostprijzen voor economische evaluaties in de gezondheidszorg. Diemen: Instituut voor Medical Technology Assessment, Erasmus MC in opdracht van College voor zorgverzekeringen. • Swarte, P. (sd). Opgeroepen op july 5, 2009, van Praktijk Swarte : http://www.praktijkswarte.nl

18. References • American Psychiatric Association. (2005). Diagnostic and Statistical Manual of Mental Disorder 4th Edition. USA, Washington DC: American Psychiatric Association. • Asselt van, A. D. (2008). Out-patient Psychotherapy for Borderline Personality Disorder: Cost-effectivness of Schema-focused Therapy vs. Transference-focused Psychtherapy. The British Journal of Psychiatry , pp. 192,450-457. • Dirksen, C. (2009, June 30). Quality of life in HTA-studies. (D. o. Dept.of Clinical Epidemiology and Medical Technology Assessment, ) • Drummond, M. F. (2005). Methods for the Economic Evaluation of Health Care Programmes. UK, Oxford: Oxford University Press. • Fergenbaum, J. (2007, Februar). Dialectical Behaviour Therapy: An Increasing evidence. Journal of Mental Health , pp. 16(1):51-68.