Psychodynamic psychotherapy is associated with sustained reduction in health care utilization and cost

Abstract

Our objective was to examine the effectiveness and efficiency of psychodynamic psychotherapy on the reduction in health care utilization and cost while controlling for age, gender, and year. Health care utilization and cost were examined yearly in 1,675 patients from 2 years before outpatient psychotherapy (i.e., baseline) to three consecutive years after psychotherapy in a naturalistic longitudinal design. A multilevel analytic approach (LMLM) was applied to account for repeated measures effect and missing data. In the year prior to psychotherapy, there was a significant increase in total cost compared with baseline (14.8%) and in use of health care services (primary and specialist doctors' visits and outsourced referrals). In the first year following therapy, there was a significant decrease in total cost (10%) and in use of health care services (all doctors' visits, imaging, and outsourced referrals). The decrease was to baseline levels or lower and was maintained for two additional years. Psychiatric medication usage increased significantly after psychotherapy and remained so. The overall cumulative decrease in total cost per patient over 3 years after therapy was 3,665.92 NIS, equalling a 69% average cost of psychotherapy. Further cost saving can be expected due to the reduction in sick leave, disability, and psychiatric hospitalization. These findings support the notion that providing outpatient psychodynamic psychotherapy can be financially beneficial to health care systems, although further research is required for causal inferences. Also, an increase in health care utilization along with scarce physical findings may indicate unaddressed psychological distress and warrant referral for mental assessment and possible psychotherapy.

Sick leave before, during, and after short-term outpatient psychotherapy: a cohort study on sick leave days and health care costs between behavioral and psychodynamic psychotherapies on anonymized claims data

“…Considering a possibly strong association between sick leave and health care utilization and resulting costs, the equivalent trend in direct costs and sick leave is not surprising and further supports a similarity in treatment effects for both BT and PDT. These results are also in accordance with cost-effectiveness analyses of short-term outpatient psychotherapies and health economic studies on mental disorders (Bode, Götz von Olenhusen, Wunsch, Kliem, & Kröger, 2017;Bothe, Jacob, Kröger, & Walker, 2020;Mukuria et al, 2013;Radhakrishnan et al, 2013;Yonatan-Leus, Strauss, & Cooper-Kazaz, 2021). Contrarily to increasing sick leave days from before to during treatment, patients who received PDT showed similar (4383 v. 4301 EUR) and patients who received BT slightly lower costs (4333 v. 4105 EUR) during therapy compared to before.…”

Systematic review of machine learning utilization within outpatient psychodynamic psychotherapy research

“…Outpatient psychodynamic psychotherapy is effective in treating various psychological disorders (1)(2)(3). Further positive effects include a reduced number of sick leaves, a reduction of health care utilization, less psychiatric hospitalizations after therapy, and a reduced relapse rates for depression (4)(5)(6). A number of factors that predict successful therapy are also known, such as improving the working alliance (7,8), therapeutic agency (7,9,10) or the patient's ability to perceive emotions (11,12) which lead to a reduction in symptom burden.…”

The case for remote supervision

“…As the pressure to meet state regulations has mounted in the public sector, and insurance companies reduce the number of sessions they cover in a year, the emphasis on evidence‐based treatments (EBT), most often in the form of Cognitive Behavioral Therapy (CBT), continues unabated despite the fact that evidence collected and published over several years demonstrates that psychodynamic treatment is as effective and, in the long term, more effective than CBT, (See Chiesa et al., 2021, Shedler, 2010, Yonatan‐Lews et al., 2021, among many others). Most recently, a meta‐analysis (Cuijpers et al., 2023) examines whether CBT is superior to other therapies and finds weak to nonexistent evidence of such superiority.…”