1
|
Horn EK, Verheul R, Thunnissen M, Delimon J, Goorden M, Hakkaart-van Roijen L, Soons M, Meerman AMMA, Ziegler UM, Rossum BV, Stijnen T, Emmelkamp PMG, Busschbach JJV. Cost-Effectiveness of Short-Term Inpatient Psychotherapy Based on Transactional Analysis in Patients With Personality Disorder. J Pers Disord 2016; 30:483-501. [PMID: 26305396 DOI: 10.1521/pedi_2015_29_210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Short-term inpatient psychotherapy based on transactional analysis (STIP-TA) in patients with personality disorders (PD) has shown to be more effective than comparable other specialized psychotherapies (OP). The aim of this study was to assess whether the higher effectiveness of STIP-TA also results in a better cost-effectiveness. Patients treated with STIP-TA were matched with patients treated with OP by the propensity score. Healthcare costs and lost productivity costs were measured over 3 years and from the societal perspective. Cost-effectiveness was represented by costs per quality adjusted life years (QALYs). Uncertainty was assessed using bootstrapping. Mean 3-year costs were €59,834 for STIP-TA and €69,337 for OP, a difference of -€9,503, 95% CI [-32,561, 15,726]. QALYs were 2.29 for STIP-TA and 2.05 for OP, a difference of .24, 95% CI [.05, .44]. STIP-TA is a dominant treatment compared to OP: less costly and more effective. We conclude that STIP-TA is a cost-effective treatment in PD patients.
Collapse
Affiliation(s)
- Eva K Horn
- Viersprong Institute for Studies on Personality Disorders (VISPD), Bergen op Zoom, The Netherlands.,Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, The Netherlands
| | - Roel Verheul
- Viersprong Institute for Studies on Personality Disorders (VISPD), Bergen op Zoom, The Netherlands.,Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Moniek Thunnissen
- GGZ WNB, Bergen op Zoom, The Netherlands.,Private Practice, Bergen op Zoom, The Netherlands
| | - Jos Delimon
- Viersprong Institute for Studies on Personality Disorders (VISPD), Bergen op Zoom, The Netherlands
| | - Maartje Goorden
- Institute for Medical Technology Assessment (iMTA), Erasmus University, Rotterdam, The Netherlands
| | | | | | | | | | | | - Theo Stijnen
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Paul M G Emmelkamp
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.,The Center for Social and Humanities Research, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Jan J V Busschbach
- Viersprong Institute for Studies on Personality Disorders (VISPD), Bergen op Zoom, The Netherlands.,Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, The Netherlands
| |
Collapse
|
2
|
Horn EK, Verheul R, Thunnissen M, Delimon J, Soons M, Meerman AMMA, Ziegler UM, Rossum BV, Andrea H, Stijnen T, Emmelkamp PMG, Busschbach JJV. Effectiveness of Short-Term Inpatient Psychotherapy Based on Transactional Analysis With Patients With Personality Disorders: A Matched Control Study Using Propensity Score. J Pers Disord 2015; 29:663-83. [PMID: 25248020 DOI: 10.1521/pedi_2014_28_166] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Controlled studies on the effectiveness of inpatient psychotherapy with patients with personality disorders (PD) are rare. This study aims to compare 3-month short-term inpatient psychotherapy based on transactional analysis (STIP-TA) with other psychotherapies (OP) up to 36-month follow-up. PD patients treated with STIP-TA were matched with OP patients using the propensity score. The primary outcome measure was general psychiatric symptomatology; secondary outcomes were psychosocial functioning and quality of life. In 67 pairs of patients, both STIP-TA and OP showed large symptomatic and functional improvements. However, STIP-TA patients showed more symptomatic improvement at all time points compared to OP patients. At 36 months, 68% of STIP-TA patients were symptomatically recovered compared to 48% of OP patients. STIP-TA outperformed OP in terms of improvements in general psychiatric symptomatology and quality of life. Superiority of STIP-TA was most pronounced at 12-month follow-up, but remained intact over the course of the 3-year follow-up.
Collapse
Affiliation(s)
| | | | | | - Jos Delimon
- De Viersprong Netherlands Institute for Personality Disorders, Halsteren
| | | | | | | | | | | | - Theo Stijnen
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden
| | | | | |
Collapse
|
3
|
Horn EK, Bartak A, Meerman AMMA, Rossum BV, Ziegler UM, Thunnissen M, Soons M, Andrea H, Hamers EFM, Emmelkamp PMG, Stijnen T, Busschbach JJV, Verheul R. Effectiveness of Psychotherapy in Personality Disorders Not Otherwise Specified: A Comparison of Different Treatment Modalities. Clin Psychol Psychother 2014; 22:426-42. [PMID: 24889151 DOI: 10.1002/cpp.1904] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 04/14/2014] [Accepted: 04/15/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Although personality disorder not otherwise specified (PDNOS) is highly prevalent and associated with a high burden of disease, only a few treatment studies in this patient group exist. This study is the first to investigate the effectiveness of different modalities of psychotherapy in patients with PDNOS, i.e., short-term (up to 6 months) and long-term (more than 6 months) outpatient, day hospital, and inpatient psychotherapy. METHOD A total of 205 patients with PDNOS were assigned to one of six treatment modalities. Effectiveness was assessed over 60 months after baseline. The primary outcome measure was symptom severity, and the secondary outcome measures included psychosocial functioning and quality of life. The study design was quasi-experimental, and the multiple propensity score was used to control for initial differences between treatment groups. RESULTS All treatment modalities showed positive outcomes, especially in terms of improvements of symptom severity and social role functioning. At 12-month follow-up, after adjustment for initial differences between the treatment groups, short-term outpatient psychotherapy and short-term inpatient psychotherapy showed most improvement and generally outperformed the other modalities concerning symptom severity. At 60 months after baseline, effectiveness remained but observed differences between modalities mostly diminished. CONCLUSION Patients with PDNOS benefit from psychotherapy both at short-term and long-term follow-up. Short-term outpatient psychotherapy and short-term inpatient psychotherapy seem to be superior to the other treatment modalities at 12-month follow-up. At 60-month follow-up, treatments showed mostly comparable effectiveness. KEY PRACTITIONER MESSAGES The effectiveness of different modalities of psychotherapy in patients with PDNOS (i.e., short-term vs long-term; outpatient versus day hospital versus inpatient psychotherapy) has not yet been compared. Different modalities of psychotherapy are effective for patients with PDNOS, and positive effects remain after 5 years. In patients with PDNOS short-term (less than 6 months) outpatient psychotherapy and short-term inpatient psychotherapy seem to be superior to the four other treatment modalities at 12-month follow-up. At 60-month follow-up, treatments showed mostly comparable effectiveness.
Collapse
Affiliation(s)
- Eva K Horn
- Viersprong Institute for Studies on Personality Disorders (VISPD), Bergen op Zoom, The Netherlands.,Department of Psychiatry, section Medical Psychology and Psychotherapy, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Anna Bartak
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.,Bos en Lommer Private Practice, Amsterdam, The Netherlands
| | | | | | | | - Moniek Thunnissen
- GGZ WNB, Bergen op Zoom, The Netherlands.,Private Practice, Bergen op Zoom, The Netherlands
| | | | - Helene Andrea
- GGZ Breburg, Tilburg, The Netherlands.,Tranzo Scientific Centre for Care and Welfare, Faculty of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Elisabeth F M Hamers
- De Viersprong, Netherlands Institute for Personality Disorders, Halsteren, The Netherlands
| | - Paul M G Emmelkamp
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.,The Center for Social and Humanities Research, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Theo Stijnen
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jan J V Busschbach
- Viersprong Institute for Studies on Personality Disorders (VISPD), Bergen op Zoom, The Netherlands.,Department of Psychiatry, section Medical Psychology and Psychotherapy, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Roel Verheul
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.,De Viersprong, Netherlands Institute for Personality Disorders, Halsteren, The Netherlands
| |
Collapse
|
4
|
Mueller U, Weiss MS, Sanchez-Weatherby J, Sorensen TLM, Thunnissen M, Ursby T, Gobbo A, Russi SR, Bowler MW, Cipriani F. Improvement of the diffraction quality of macromolecular crystals at European synchrotrons using the HC1 dehydration control device. Acta Crystallogr A 2012. [DOI: 10.1107/s0108767312099734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
5
|
Thunnissen M, Appio R, Unge J, Fredslund F, Plivelic T, Haas S, Logan DT, Ursby T, Labrador A. The Cassiopeia suite of beamlines at the MAX IV laboratory. Acta Crystallogr A 2012. [DOI: 10.1107/s0108767312097176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
6
|
Thunnissen M, Unge J, Labrador A, Logan DT, Ursby T. BioMAX, a multipurpose high-throughput crystallography beamline at MAX IV. Acta Crystallogr A 2012. [DOI: 10.1107/s0108767312097188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
7
|
Hasan M, Förnvik K, Thunnissen M, Riesbeck K. Crystallization of MID962-1200: a trimeric autotransporter from M. catarrhalis. Acta Crystallogr A 2011. [DOI: 10.1107/s0108767311087861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
8
|
Ursby T, Logan D, Neutze R, Schneider G, Thunnissen M. MAX IV MX: macromolecular crystallography at the new MAX IV 3 GeV storage ring. Acta Crystallogr A 2011. [DOI: 10.1107/s0108767311079426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
9
|
Bartak A, Andrea H, Spreeuwenberg MD, Thunnissen M, Ziegler UM, Dekker J, Bouvy F, Hamers EFM, Meerman AMMA, Busschbach JJV, Verheul R, Stijnen T, Emmelkamp PMG. Patients with cluster a personality disorders in psychotherapy: an effectiveness study. Psychother Psychosom 2011; 80:88-99. [PMID: 21196806 DOI: 10.1159/000320587] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 08/22/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND While psychopharmacological studies are common in patients with cluster A personality disorders, the effects of psychotherapy have received little attention. The aim of this study is to explore whether psychotherapeutic treatment yields health gains for these patients. METHODS The study was conducted between March 2003 and June 2008 in 6 mental health care centres in the Netherlands, with a sample of 57 patients with a DSM-IV-TR axis II cluster A diagnosis. Patients were assigned to 3 settings of psychotherapeutic treatment (outpatient, day hospital, inpatient), and effectiveness was assessed at 18 months after baseline. An intention-to-treat analysis was conducted for psychiatric symptoms (Brief Symptom Inventory), psychosocial functioning (Outcome Questionnaire-45) and quality of life (EQ-5D), using multilevel statistical modelling. As the study was non-randomised, the propensity score method was used to control for initial differences. RESULTS Patients in the day hospital and inpatient group improved substantially in terms of psychiatric symptoms, social and interpersonal functioning, and quality of life. Patients in the outpatient group showed less improvement. Direct comparison of the improvement of psychiatric symptoms showed significant results in favour of day hospital (p = 0.046) and inpatient (p = 0.01) treatment, as compared to outpatient treatment. However, due to substantial baseline differences, this direct comparison should be judged carefully. CONCLUSIONS Cluster A psychopathology is not a contraindication to benefit from psychotherapy. This is especially true for more intensive forms like inpatient and day hospital treatment. Future research should focus more on psychotherapeutic treatment to gain further insight into effective treatment options for this patient group.
Collapse
Affiliation(s)
- Anna Bartak
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Soeteman DI, Verheul R, Meerman AMMA, Ziegler U, Rossum BV, Delimon J, Rijnierse P, Thunnissen M, Busschbach JJV, Kim JJ. Cost-effectiveness of psychotherapy for cluster C personality disorders: a decision-analytic model in the Netherlands. J Clin Psychiatry 2011; 72:51-9. [PMID: 21034679 DOI: 10.4088/jcp.09m05228blu] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Accepted: 08/03/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To conduct a formal economic evaluation of various dosages of psychotherapy for patients with avoidant, dependent, and obsessive-compulsive (ie, cluster C) personality disorders (Structured Interview for DSM-IV Personality criteria). METHOD We developed a decision-analytic model to assess the cost-effectiveness of 5 dosages of psychotherapy (ie, long-term outpatient psychotherapy, short-term and long-term day hospital psychotherapy, and short-term and long-term inpatient psychotherapy) over a 5-year time horizon in terms of cost per recovered patient-year and cost per quality-adjusted life-year (QALY). Model parameters were estimated using data from 466 patients with cluster C personality disorders who were admitted to 6 specialist centers of psychotherapy in The Netherlands and assigned to 1 of the 5 treatment groups. Probabilistic analysis was conducted to explore the stability of results over uncertain data ranges. Analyses were conducted from both societal and payer perspectives. RESULTS From the societal perspective and below a threshold of € 2,637 (US $3,351.92) per recovered patient-year, short-term day hospital psychotherapy resulted in the highest level of benefit for its cost; above the threshold, short-term inpatient psychotherapy was the most cost-effective choice. In terms of cost per QALY, this switch point was at a threshold value of € 16,570 (US $21,062.29) per QALY. From the payer perspective, the optimal strategy changed from short-term day hospital psychotherapy to short-term inpatient psychotherapy at threshold values of € 9,874 (US $12,550.94) per recovered patient-year and € 66,302 (US $84,277.13) per QALY. CONCLUSIONS This study indicates that short-term day hospital psychotherapy and short-term inpatient psychotherapy are the most cost-effective treatment strategies for patients with cluster C personality disorders. The ultimate selection depends on what cost-effectiveness threshold is considered acceptable and what perspective is adopted.
Collapse
Affiliation(s)
- Djøra I Soeteman
- Viersprong Institute for Studies on Personality Disorders (VISPD), PO Box 7, 4660 AA Halsteren, The Netherlands.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Soeteman DI, Verheul R, Delimon J, Meerman AMMA, van den Eijnden E, Rossum BV, Ziegler U, Thunnissen M, Busschbach JJV, Kim JJ. Cost-effectiveness of psychotherapy for cluster B personality disorders. Br J Psychiatry 2010; 196:396-403. [PMID: 20435967 DOI: 10.1192/bjp.bp.109.070482] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
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 12,274 euros per recovered patient-year; and from day hospital to in-patient psychotherapy at 113,298 euros. In terms of cost per QALY, the optimal strategy changed at 56,325 euros and 286,493 euros per QALY respectively. From the payer perspective, the switch points were at 9895 euros and 155,797 euros per recovered patient-year, and 43,427 euros and 561,188 euros 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.
Collapse
Affiliation(s)
- Djøra I Soeteman
- Department of Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, The Netherlands.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Thunnissen M, Duivenvoorden H, Busschbach J, Hakkaart-van Roijen L, van Tilburg W, Verheul R, Trijsburg W. A randomized clinical trial on the effectiveness of a reintegration training program versus booster sessions after short-term inpatient psychotherapy. J Pers Disord 2008; 22:483-95. [PMID: 18834296 DOI: 10.1521/pedi.2008.22.5.483] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although several studies show symptomatic improvements in patients with personality disorders after short-term inpatient psychotherapy, reintegration remains difficult. In this study the effectiveness of a specifically designed reintegration training program is investigated. One hundred twenty-eight patients were randomized to either a reintegration training program aimed at improving general functioning and work resumption, or booster sessions. Outcome measures used were symptom level, work status, absence from and impediments at work. The results showed that compliance in the booster session group was significantly better than in the reintegration training program. The percentage of persons with a paid job increased during the booster sessions from 64 to 87%, but not during the reintegration training (76%). There were no differences in the other outcome measures. We concluded that reintegration training was not more (cost)-effective than booster sessions. Our hypothesis is that continuity of care (same therapists and program) explains the favorable results of the booster sessions.
Collapse
Affiliation(s)
- Moniek Thunnissen
- GGZ WNB Mental Health Care West North Brabant, Halsteren, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
13
|
Ekberg M, Pötsch S, Sandin E, Thunnissen M, Nordlund P, Sahlin M, Sjöberg BM. Preserved catalytic activity in an engineered ribonucleotide reductase R2 protein with a nonphysiological radical transfer pathway. The importance of hydrogen bond connections between the participating residues. J Biol Chem 1998; 273:21003-8. [PMID: 9694851 DOI: 10.1074/jbc.273.33.21003] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A hydrogen-bonded catalytic radical transfer pathway in Escherichia coli ribonucleotide reductase (RNR) is evident from the three-dimensional structures of the R1 and R2 proteins, phylogenetic studies, and site-directed mutagenesis experiments. Current knowledge of electron transfer processes is difficult to apply to the very long radical transfer pathway in RNR. To explore the importance of the hydrogen bonds between the participating residues, we converted the protein R2 residue Asp237, one of the conserved residues along the radical transfer route, to an asparagine and a glutamate residue in two separate mutant proteins. In this study, we show that the D237E mutant is catalytically active and has hydrogen bond connections similar to that of the wild type protein. This is the first reported mutant protein that affects the radical transfer pathway while catalytic activity is preserved. The D237N mutant is catalytically inactive, and its tyrosyl radical is unstable, although the mutant can form a diferric-oxo iron center and a R1-R2 complex. The data strongly support our hypothesis that an absolute requirement for radical transfer during catalysis in ribonucleotide reductase is an intact hydrogen-bonded pathway between the radical site in protein R2 and the substrate binding site in R1. Our data thus strongly favor the idea that the electron transfer mechanism in RNR is coupled with proton transfer, i.e. a radical transfer mechanism.
Collapse
Affiliation(s)
- M Ekberg
- Departments of Molecular Biology, University of Stockholm, S-10691 Stockholm, Sweden
| | | | | | | | | | | | | |
Collapse
|