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The Economic Burden of Personality Disorders

The Economic Burden of Personality Disorders. Djøra Soeteman, Jan J.V. Busschbach, Leona Hakkaart-van Roijen, Roel Verheul Viersprong Institute for Studies on Personality Disorders (VISPD), The Netherlands; Erasmus MC Rotterdam, Department of Medical Psychology and Psychotherapy;

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The Economic Burden of Personality Disorders

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  1. The Economic Burden of Personality Disorders • Djøra Soeteman, Jan J.V. Busschbach, Leona Hakkaart-van Roijen, Roel Verheul • Viersprong Institute for Studies on Personality Disorders (VISPD), The Netherlands; • Erasmus MC Rotterdam, Department of Medical Psychology and Psychotherapy; • Erasmus MC Rotterdam, Institute for Medical Technology Assessment (iMTA); • University of Amsterdam, Department of Clinical Psychology

  2. Limited evidence on the economic burden • Evidence seems to indicate high costs • Health care resources • Prison services • Social care • Productivity losses • Borderline PD seems most expensive • Bender et al., 2001 • State-of-the-art economic assessments are lacking • Should include both direct and indirect costs • Medical and productivity losses • Standardized diagnoses

  3. Patients recruitment • SCEPTRE • Study on the Cost-Effectiveness of Personality disorder TREatment • Six mental health care institutes • Offering outpatient, day hospital and/or inpatient psychotherapy for adult patients with personality pathology and/or personality disorders • Instruments part of the standard admission procedure • Thus all applicants were included

  4. Inclusion / exclusion • 2540 individuals registered as admissions • 462 (18.2%) did not start • 272 (10.7%) did not complete the admission procedure. • Of the remaining 1806 patients: • 41 were excluded due to clear signs of unreliable data (2.3%) • 5 due to serious intellectual impairment (0.3%) • The questionnaire for estimating costs (TiC-P) was missing for 20 patients (1.1%) • Leaving 1740 patients in current sample • 96.3% of those who completed the formal assessment procedure

  5. Instruments • Trimbos and iMTA questionnaire on Costs associated with Psychiatric illness (TiC-P) • Direct and indirect costs • Number of visits to a general practitioner, psychiatrist, medical specialist, physiotherapist, and alternative health practitioner • Day care/hospital lengths of stay • Use of medication • All in the 4 weeks prior to filling out the questionnaire • Productivity losses • Two weeks prior to filling out the questionnaire • Friction costs valuation

  6. Instruments • SIDP-IV • Structured Interview of DSM-IV Personality Disorders • 11 formal DSM –IV-TR Axis II diagnoses • e.g., schizoid personality disorder • Including personality disorder not-otherwise-specified • 2 DSM-IV-TR appendix diagnoses • depressive and negativistic personality disorder • DSM-III-R self-defeating personality disorder • Trained interviewers • Booster sessions

  7. Patient characteristics • Most frequently diagnosed • Depressive 31.8% • Avoidant 28.3% • Obsessive-compulsive 20.9% • Borderline 20.9% • Least frequent • Schizotypal 1.0% • Schizoid 1.1% • One-fifth no personality disorder diagnosis • 68% without paying jobs because of health-related problems

  8. Statistical analyses • Univariate regression • Comparison of each PD type vs the non-PD patients • Multiple regression • Main effect analysis • measuring the unique contribution of the different diagnoses on the costs • Age, gender and education (socio-economic status) • associated with health service use and were therefore entered into the multiple regression models • Number of diagnoses: 54.9% at least two diagnoses of PD

  9. Direct medical costs

  10. Productivity losses

  11. PD types vs. non-PD patients

  12. Results multivariate analysis • None of the specific diagnoses significantly predicted variations in costs • Categorical variables: yes/no diagnosis • P > 0.05 • Differences accompanied by large variances • Total number of PD diagnoses no effect • R2 = 1.3%

  13. Diagnoses more continuous • Borderline, obsessive-compulsive and narcissistic (-) PD unique contribution on total costs • Ranked: none-trait-definite • P<0.05 • Total number of PD diagnoses still no effect • Maximum variance explained by all variables: 3.6%

  14. Conclusions • Personality disorders pose a substantial economic burden on society • Effective treatments are potentially also cost-effective • Especially if these treatments appear capable of reducing this economic burden • Considering PD in traits • In a treatment-seeking population • Borderline and obsessive-compulsive PD were found to be more costly to society • Narcissistic PD predicted lower costs

  15. Contact • www.vispd.nl

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