Cost-effectiveness of psychotherapy for cluster B personality disorders

Declaration of interest: None.
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 {euro}12 274 per recovered patient-year; and from day hospital to in-patient psychotherapy at {euro}113 298. In terms of cost per QALY, the optimal strategy changed at {euro}56 325 and {euro}286 493 per QALY respectively. From the payer perspective, the switch points were at {euro}9895 and {euro}155 797 per recovered patient-year, and {euro}43 427 and {euro}561 188 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.