Health service costs and clinical gains of psychotherapy for personality disorders: a randomized controlled trial of day-hospital-based step-down treatment versus outpatient treatment at a specialist practice.

摘要: Day-hospital-based treatment programmes have been recommended for poorly functioning patients with personality disorders (PD). However, more research is needed to confirm the cost-effectiveness of such extensive over other, presumably simpler, formats. This study compared health service costs and psychosocial PD randomly allocated either a day-hospital-based programme combining individual group psychotherapy in step-down format, or outpatient at specialist practice. It included 107 patients, 46% whom had borderline PD, 40% avoidant PD. Costs two conditions additional primary secondary in- services. Psychosocial was assessed using measures global (observer-rated GAF) occupational (self-report) functioning. Repeated assessments three years were analysed mixed models. The higher than those treatment, but these high compensated by considerably lower other clinical gains depended on type For did not differ condition. Health declined during trial, improved mild impairment levels (GAF > 60). considerable adjuvant services expanded format. Clinical improvements nevertheless superior Our results indicate that decisions format should differentiate between types. differ. better alternative, leaning, however, costly early phase treatment. Trials NCT00378248