Mentalization-Based Treatment Versus Specialist Treatment as Usual for Borderline Personality Disorder: Economic Evaluation Alongside a Randomized Controlled Trial With 36-Month Follow-Up

Blankers, Matthijs; Koppers, David; Laurenssen, Elisabeth M. P.; Peen, Jaap; Smits, Maaike L; Luyten, Patrick; Busschbach, Jan J. V.; Kamphuis, Jan H.; Kikkert, Martijn; Dekker, Jack

doi:10.1521/pedi_2019_33_454

Cited by 11 publications

(12 citation statements)

References 47 publications

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“…27 Seven studies only recruited participants with a diagnosis of borderline personality disorder. 16, 18,19,23,26,29,31 Nine of the studies required a recent episode of self-harm, attendance at an emergency department or in-patient stay. 15,17–21,23,29 Two studies only included patients with other comorbid severe mental illness 24 and one of the two also required substance dependence.…”

Section: Resultsmentioning

confidence: 99%

“…Four studies were identified which looked at other interventions: joint crisis plans, 29 psychoeducation with problem-solving, 30 clarification-oriented psychotherapy (COP) 14 and mentalisation-based treatment delivered in a day hospital (MBT). 31 All of them used RCT data and employed a CUA, and two of these studies (Blankers et al 31 and Bamelis et al 14 ) also conducted a CEA. All of these studies took a broad perspective.…”

Section: Resultsmentioning

confidence: 99%

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Community interventions for people with complex emotional needs that meet the criteria for personality disorder diagnoses: systematic review of economic evaluations and expert commentary

Clark

Steare

et al. 2021

BJPsych open

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Background Diagnoses of personality disorder are prevalent among people using community secondary mental health services. Identifying cost-effective community-based interventions is important when working with finite resources. Aims To assess the cost-effectiveness of primary or secondary care community-based interventions for people with complex emotional needs who meet criteria for a diagnosis of personality disorder to inform healthcare policy-making. Method Systematic review (PROSPERO: CRD42020134068) of databases. We included economic evaluations of interventions for adults with complex emotional needs associated with a diagnosis of personality disorder in community mental health settings published before 18 September 2019. Study quality was assessed using the CHEERS statement. Results Eighteen studies were included. The studies mainly evaluated psychotherapeutic interventions. Studies were also identified that evaluated altering the setting in which care was delivered and joint crisis plans. No strong economic evidence to support a single intervention or model of community-based care was identified. Conclusions Robust economic evidence to support a single intervention or model of community-based care for people with complex emotional needs is lacking. The strongest evidence was for dialectical behaviour therapy, with all three identified studies indicating that it is likely to be cost-effective in community settings compared with treatment as usual. More robust evidence is required on the cost-effectiveness of community-based interventions on which decision makers can confidently base guidelines or allocate resources. The evidence should be based on consistent measures of costs and outcomes with sufficient sample sizes to demonstrate impacts on these.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Community interventions for people with complex emotional needs that meet the criteria for personality disorder diagnoses: systematic review of economic evaluations and expert commentary

Clark

Steare

et al. 2021

BJPsych open

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“…Three of the evaluations looked at ‘Cluster C personality disorders’, described as avoidant, dependent, obsessive-compulsive (Bamelis et al 2015a, Bamelis et al 2015b, Soeteman et al 2011) (14,20) and one study looked at ‘Cluster B personality disorders’ described as antisocial, borderline, histrionic, and narcissistic (Soeteman et al 2010) (21). Eight studies only recruited participants with a ‘borderline personality disorder’ diagnosis (Blankers et al 2019, Borschmann et al 2013, Davidson et al 2010, Palmer et al 2006, Pasieczny & Connor 2011, Sinnaeve et al 2018, van Asselt et al 2008) (22–28). Nine of the studies required a recent episode of self-harm, attendance at an emergency department, or in-patient stay (Borschmann et al 2013, Davidson et al 2010, Grenyer et al 2018, Murphy et al 2019, Palmer et al 2006, Pasieczny & Connor 2011, Priebe et al 2012, Sinnaeve et al 2018, Tyrer et al 2004) (15,18,23–27,29,30).…”

Section: Resultsmentioning

confidence: 99%

“…Four studies were identified which looked at other interventions: joint crisis plans (JCPs) (23), psycho-education with problem solving (PEPS) (16), clarification orientated psychotherapy (COP) (14) and mentalization-based treatment delivered in a day hospital (MBT) (22). All of them used randomised controlled trial data and employed a CUA, and two of these studies, Blankers et al and Bamelis et al (2015b), also conducted a CEA (Table 2).…”

Section: Resultsmentioning

confidence: 99%

Community interventions for people with complex emotional needs that meet the criteria for ‘personality disorder’ diagnoses: a systematic review of economic evaluations

Clark

Steare

et al. 2020

Preprint

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Background Diagnoses of personality disorder are prevalent among people using community secondary mental health services. Whilst the effectiveness of a range of community-based treatments have been considered, as the NHS budget is finite, it is also important to consider the cost-effectiveness of those interventions. Aims To assess the cost-effectiveness of primary or secondary care community-based interventions for people with complex emotional needs that meet criteria for a diagnosis of personality disorder to inform healthcare policy making. Method Systematic review (PRESPORO #: CRD42020134068) of five databases, supplemented by reference list screening and citation tracking of included papers. We included economic evaluations of interventions for adults with complex emotional needs associated with a diagnosis of personality disorder in community mental health settings published between before 18 September 2019. Study quality was assessed using the CHEERS statement. Narrative synthesis was used to summarise study findings. Results Eighteen studies were included. The studies mainly evaluated psychotherapeutic interventions. Studies were also identified which evaluated altering the setting in which care was delivered and joint crisis plans. No strong economic evidence to support a single intervention or model of community-based care was identified. Conclusion There is no robust economic evidence to support a single intervention or model of community-based care for people with complex emotional needs. The review identified the strongest evidence for Dialectical Behavioural Therapy with all three identified studies indicating the intervention is likely to be cost-effective in community settings compared to treatment as usual. Further research is needed to provide robust evidence on the cost-effectiveness of community-based interventions upon which decision makers can confidently base guidelines or allocate resources.

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“…A study by van Asselt et al (2009) showed that it is quite responsive for treatment improvement in borderline personality disorder (BPD). However, several studies also report remarkable discrepancies between clinical improvement in BPD patients and improvement in EQ-5D scores (Blankers et al, 2019;van Asselt et al, 2008). When quality of life was studied in a broader approach by Cramer et al (2007), the presence of a PD appeared to be the strongest negative predictor of quality of life.…”

Section: Discussionmentioning

confidence: 99%

Exploring differences in quality of life in clinical populations of depressed outpatients with and without personality disorders

Kool

Lemmens

Hartog

et al. 2021

Journal of Affective Disorders

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Mentalization-Based Treatment Versus Specialist Treatment as Usual for Borderline Personality Disorder: Economic Evaluation Alongside a Randomized Controlled Trial With 36-Month Follow-Up

Cited by 11 publications

References 47 publications

Community interventions for people with complex emotional needs that meet the criteria for personality disorder diagnoses: systematic review of economic evaluations and expert commentary

Community interventions for people with complex emotional needs that meet the criteria for personality disorder diagnoses: systematic review of economic evaluations and expert commentary

Community interventions for people with complex emotional needs that meet the criteria for ‘personality disorder’ diagnoses: a systematic review of economic evaluations

Exploring differences in quality of life in clinical populations of depressed outpatients with and without personality disorders

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