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Cost-effectiveness of Brief Psychodynamic-Interpersonal Therapy in High Utilizers of Psychiatric Services
Elspeth Guthrie, MD;
James Moorey, MSc;
Frank Margison, MD;
Helen Barker, MRCPsych;
Stephen Palmer, MSc;
Graeme McGrath, PhD;
Barbara Tomenson, MSc;
Francis Creed, MD
Arch Gen Psychiatry. 1999;56:519-526.
Background It is known that a small number of patients with mental health problems have chronic disorders and account for a disproportionate amount of mental health costs. This randomized controlled trial evaluated the cost-effectiveness of psychodynamic-interpersonal therapy vs treatment as usual in patients with mental health problems who were unresponsive to usual treatment.
Method Subjects (N=110) with nonpsychotic disorders unresponsive to 6 months of routine specialist mental health treatment were enrolled in a randomized controlled trial. Sixty-three percent were women, the mean age was 41.4 years, the median duration of illness was 5 years, 68% were unemployed or receiving state benefits because of illness, and 75.5% had a depressive illness. Intervention patients received 8 weekly sessions of psychodynamic-interpersonal psychotherapy. Control patients received usual care from their psychiatrist. Outcome measures included ratings of psychological distress and health status and a detailed economic evaluation. Analysis was conducted on an intent-to-treat basis.
Results Subjects randomized to psychotherapy had a significantly greater improvement than controls in psychological distress and social functioning 6 months after the trial. Baseline treatment costs were similar for both groups. Subjects who received psychotherapy showed significant reductions in the cost of health care utilization in the 6 months after treatment compared with controls. The extra cost of psychotherapy was recouped within 6 months through reductions in health care use.
Conclusion These preliminary findings suggest that brief psychodynamic-interpersonal therapy may be cost-effective relative to usual care for patients with enduring nonpsychotic symptoms who are not helped by conventional psychiatric treatment.
From the School of Psychiatry and Behavioural Sciences, University of Manchester, Manchester, England (Drs Guthrie, Margison, Barker, McGrath, and Creed, Mr Moorey, and Ms Tomenson); and the Centre for Health Economics, University of York, York, England (Mr Palmer).
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