Background Recommendations on current clinical guidelines are informed by limited economic evidence. Aims A formal economic evaluation of three modalities of psychotherapy for patients with cluster B personality disorders. Method A probabilistic decision-analytic model to assess the cost- effectiveness of out-patient, day hospital and in-patient psychotherapy over 5 years in terms of cost per recovered patient-year and cost per quality-adjusted life-year (QALY). Analyses were conducted from both societal and payer perspectives. Results From the societal perspective, the most cost-effective choice switched from out-patient to day hospital psychotherapy at a threshold of e12 274 per recovered patient-year; and from day hospital to in-patient psychotherapy at e113 298. In terms of cost per QALY, the optimal strategy changed at e56 325 and e286 493 per QALY respectively. From the payer perspective, the switch points were at e9895 and e155 797 per recovered patient-year, and e43 427 and e561 188 per QALY. Conclusions Out-patient psychotherapy and day hospital psychotherapy are the optimal treatments for patients with cluster B personality disorders in terms of cost per recovered patient- year and cost per QALY. Declaration of interest None.

*Cost of Illness, Adult, Cost-Benefit Analysis, Day Care/economics, Female, Health Care Costs/statistics & numerical data, Hospitalization/economics, Humans, Male, Netherlands, Outpatient Clinics, Hospital/economics, Personality Disorders/economics/*therapy, Psychotherapy/*economics/methods, Quality-Adjusted Life Years, Treatment Outcome, Young Adult,
British Journal of Psychiatry
Erasmus MC: University Medical Center Rotterdam

Soeteman, D.I, Verheul, R, Delimon, J, Meerman, A.M.M.A, Eijnden, E, van Rossum, B, … Kim, J.J. (2010). Cost-effectiveness of psychotherapy for cluster B personality disorders. British Journal of Psychiatry, 196(5), 396–403. doi:10.1192/bjp.bp.109.070482