The burden of disease in patients eligible for mentalization-based treatment (MBT): quality of life and costs

Abstract

BackgroundMentalization-Based Treatment (MBT) is a promising, though expensive treatment for severely ill patients with Borderline Personality Disorder (BPD). A high burden of disease in terms of quality of life (QoL) and life years lost can be a reason to prioritize mental health interventions, and specifically for BPD patients. Moreover, when the societal costs of the illness are high, spending resources on high treatment costs would be more easily legitimized. Therefore, the purpose of this study was to calculate the burden of disease of BPD patients eligible for MBT.MethodsThe 403 patients included in this study were recruited from two mental health care institutes in the Netherlands. All patients were eligible for MBT. Burden of disease consisted of QoL, measured with the EuroQol EQ-5D-3L, and costs, calculated using the Trimbos and Institute for Medical Technology Assessment Questionnaire for Costs Associated with Psychiatric Illness.ResultsThe mean QoL index score was .48. The mean total costs in the year prior to treatment were €16,879 per patient, of which 21 % consisted of productivity costs.ConclusionsThe burden of disease in BPD patients eligible for MBT is high, which makes it more likely that society is willing to invest in treatment for these patients. However, this finding should not be interpreted as a license to unlimitedly use resources to reimburse treatment for severe BPD patients, as these findings do not provide any information on the effectiveness of MBT or other available treatment programs for BPD. The effectiveness of available treatments should be evident by studies on the effectiveness of the treatment itself and by comparing the effectiveness of these treatments to treatment as usual and to other treatment options for BPD patients.Trial registrationThe data on this paper came from two trials: NTR2175 and NTR2292.

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

“…Although the numerical results varied, the negative results for MBT-DH in the cost-utility outcome and the favourable results in the cost-effectiveness outcome remained stable under the alternative scenarios and in sensitivity analyses. The finding that MBT-DH was slightly superior to S-TAU in terms of cost-effectiveness with remissions as the outcome may seem out of line with the clinical results of the comparison between MBT-DH and S-TAU by Laurenssen et al (2018). In that study, both MBT-DH and S-TAU showed significant improvements on all outcome measures at 18-month follow-up, but MBT-DH was not superior to S-TAU.…”

“…In that study, both MBT-DH and S-TAU showed significant improvements on all outcome measures at 18-month follow-up, but MBT-DH was not superior to S-TAU. The difference between the present cost-effectiveness study and the effectiveness study of Laurenssen et al (2018) is that in the present study effects are measured over a 36-month follow-up, while Laurenssen et al reported on only the first 18 months of follow-up. A number of studies have found that MBT can be more effective after a long period than a short period of follow-up (see, e.g., Bateman & Fonagy, 1999, 2001, 2008, 2009Smits et al, 2019).…”

“…Key findings are that MBT-DH is dominated by S-TAU with QALYs as the outcome, while MBT-DH is potentially cost-effective compared with S-TAU with remissions as the outcome. The median incremental cost per incremental remission (€29,000 over 36 months, or almost €10,000 per year) is somewhat lower than the estimated costs to society of a patient with unremitted BPD (approximately €15,000 per year; see Soeteman, Hakkaart-van Roijen, et al, 2008;Laurenssen et al, 2016). At a willingness to pay of €45,000 over a 36-month period for a remitted patient, there is a 55% likelihood that MBT-DH is the more cost-effective of the two interventions, and hence a 45% likelihood that S-TAU is the more cost-effective.…”

“…Borderline personality disorder (BPD) is one of the most prevalent mental disorders in psychiatric populations (Leichsenring, Leibing, Kruse, New, & Leweke, 2011;Paris, 2010) and is associated with low quality of life , high psychiatric comorbidity (Barrachina et al, 2011;Skodol et al, 1999;Trull, Sher, Minks-Brown, Durbin, & Burr, 2000;Zanarini, 1998), and, in addition, high socioeconomic burden (Laurenssen et al, 2016;Soeteman, Hakkaart-van Roijen, Verheul, & Busschbach, 2008). In pure monetary terms, the projected annual average societal cost for a BPD patient based on 2014 prices is approximately €15,000 per year, based on work by Soeteman, Hakkaart-van Roijen, et al (2008;€13,088 in the year 2005) and Laurenssen et al (2016;€16,879 per year).…”

“…In the current article, we present an economic evaluation performed alongside the RCT by Laurenssen et al (2018), which compared the costs and effects of MBT-DH and S-TAU over a 36-month follow-up period. The evaluation consists of a cost-utility analysis from a societal perspective, in which the utilities have been expressed in QALYs.…”