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Djøra Soeteman, MSc Djora.Soeteman@deviersprong +31 164 632200

The burden of disease in patients with personality disorder indicated for psychotherapy: Arguments for necessity of care. Djøra Soeteman, MSc Djora.Soeteman@deviersprong.net +31 164 632200 Psychotherapeutic Centre ‘De Viersprong’, P.O.box 7, 4660 AA Halsteren, The Netherlands

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Djøra Soeteman, MSc Djora.Soeteman@deviersprong +31 164 632200

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  1. The burden of disease in patients with personality disorder indicated for psychotherapy: Arguments for necessity of care • Djøra Soeteman, MSc • Djora.Soeteman@deviersprong.net • +31 164 632200 • Psychotherapeutic Centre ‘De Viersprong’, P.O.box 7, 4660 AA Halsteren, The Netherlands • In cooperation with the Erasmus University, Rotterdam • Reinier Timman, MSc

  2. Introduction • ‘Necessity’ (of treatment) is 1 of the 4 criteria of reimbursement policy in The Netherlands • Also internationally • YAVIS • Young, Attractive, Verbal, Intelligent and Successful • Young, Attractive, Verbal, Intelligent, and Successful • Young, Attractive, Verbal, Insightful, and Successful • Young, Attractive, Vital, Intelligent, and Successful • Young, Affluent, Verbal, Insured, and Single

  3. Introduction • Burden of disease versus cost-effectiveness • Necessary care defined in terms of burden of disease • The higher the burden of disease, the more willing we are to accept a poor cost-effectiveness • Example • Prostate problems low burden, reasonable cost-effectiveness • Lungtransplantation high burden, extreme poor cost-effectiveness • Measuring burden of disease • Consequences for Quality of Life • Quality of Life questionnaires

  4. Quality of life • “…. Health is physical, mental and social well-being and not merely the absence of disease or infirmity...” • World Health Organization, 1947 • Extending health to well-being: Quality of Life • What is the definition of Quality of Life?

  5. Definitions of Quality of Life • Quality of life is the degree of need and satisfaction within the physical, psychological, social, activity, material and structural area (Hörnquist, 1982). • Quality of life is the subjective evaluation of good and satisfactory character of life as a whole (De Haes, 1988). • Health related quality of life is the subjective experiences or preferences expressed by an individual, or members of a particular group of persons, in relation to specified aspects of health status that are meaningful, in definable ways, for that individual or group (Till, 1992). • Quality of life is a state of well-being which is a composite of two components: 1) the ability to perform everyday activities which reflects physical psychological, and social well-being and 2) patient satisfaction with levels of functioning and the control of disease and/or treatment related symptoms (Gotay et al., 1992). NO CONSENSUS

  6. How to measure Quality of Life? • Quality of Life is subjective…. • “Given its inherently subjective nature, consensus was quickly reached that quality of life ratings should, whenever possible, be elicited directly from patients themselves”.Aaronson, in B Spilker (Ed): Quality of life and Pharmacoeconomics in Clinical Trails, 1996, page 180

  7. How to measure Quality of Life? • EuroQol-5D • Developed by EuroQol Group (1987) • Self-report questionnaire • Generic instrument • Yields the possibility to compare between different diagnostic groups

  8. Descriptive system • 5 questions covering 5 dimensions: • Mobility, self-care, usual activities, pain/discomfort, anxiety/depression • 3 levels • No problems (1), some or moderate problems (2), extreme problems or unable (3) • 243 health states (35) • Values available for all 243 health states

  9. Value a health state • 22113 • ‘Some problems in walking about’ • ‘Some problems washing and dressing myself’ • ‘No problems with performing usual activities’ • ‘No pain or discomfort’ • ‘Extremely anxious or depressed’ • Value: 0.25

  10. The present study • Standard Evaluation Project (STEP) • Standard quality monitoring system • Patients who received a clinical therapy of at least two days a week were included • 861 patients were included during the admissison for psychotherapy • 19 institutes

  11. Results SCL-90

  12. Compared to (somatic) illnesses

  13. Conclusion • Patients with personality disorder who search for therapy, are patients with a severe burden of disease • Contradictory to the YAVIS argument • Any cost-effective treatment of personality disorder must be seen as necessary care for a serious illness • This statement favours the reimbursement of psychotherapy

  14. General conclusion • There is a legitimate need of care • A considerable burden of disease • Research questions • Effectiveness (in terms of dose-effect relationships) • Cost-effectiveness • Patient-treatment matching

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