Population-based cost-offset analyses for disorder-specific treatment of anorexia nervosa and bulimia nervosa in Germany.

Previous research has shown that anorexia nervosa (AN) and bulimia nervosa (BN) are expensive illnesses to treat. To reduce their economic burden, adequate interventions need to be established. Our objective was to conduct cost-offset analyses for evidence-based treatment of eating disorders using outcome data from a psychotherapy trial involving cognitive behavioral therapy (CBT) and focal psychodynamic therapy (FPT) for AN and a trial involving CBT for BN. Assuming a currently running, ideal healthcare system using a 12-month, prevalence-based approach and varying the willingness to participate in treatment, we investigated whether the potential financial benefits of AN- and BN-related treatment outweigh the therapy costs at the population level. We elaborated on a formula that allows calculating cost-benefit relationships whereby the calculation of the parameters is based on estimates from data of health institutions within the German healthcare system. Additional intangible benefits were calculated with the aid of Quality-Adjusted Life Years. The annual costs of an untreated eating disorder were 2.38 billion EUR for AN and 617.69 million EUR for BN. Independent of the willingness to participate in treatment, the cost-benefit relationships for the treatment remained constant at 2.51 (CBT) and 2.33 (FPT) for AN and 4.05 (CBT) for BN. This consistency implies that for each EUR invested in the treatment, between 2.33 and 4.05 EUR could be saved each year. Our findings suggest that the implementation of evidence-based psychotherapy treatments for AN and BN may achieve substantial cost savings at the population level.

[Interdisciplinary Care of Employees with Mental Disorders: A Fact Check Using the Salzgitter-Model as an Example]. / Interdisziplinäre Versorgung von Arbeitnehmern mit psychischen Störungen: Ein Faktencheck am Beispiel des Salzgitter-Modells.

OBJECTIVE: Mental disorders are quite common among employees, and cause enormous economic costs. The Salzgitter-Model aims at an early recognition of mental disorders in employees of raw material processing industries by rendering a diagnostic examination (DE), so that appropriate health-care services may be provided promptly. METHODS: Data of a consecutive sample consisting of 133 mentally ill employees (61% men) were analyzed. Mental disorders were diagnosed using the Structured Clinical Interview for DSM-IV. Moreover, routine data of company health insurance funds collected in the 6 months preceding the DE were evaluated. RESULTS: On average, the DE was conducted 14 days after application. Half the diagnoses were of mood disorders, while almost one third consisted of neurotic, stress-related, and somatoform disorders. For 63% of diagnoses from the DE, a correspondence was found with diagnoses made by practitioners during standard care over the previous 6 months. Of these employees, 42% received drug therapy. However more than one fifth did not receive guideline-based psychopharmacological treatment. Psychological symptoms and work-related factors were the main reasons for utilization of the DE. No employee had received psychotherapeutic treatment prior to the DE; more than 90% accepted the recommendation of treatment after the DE. CONCLUSION: Strengthened interdisciplinary cooperation can improve the utilization of an employee group that usually does not seek out specific diagnostic examinations and psychotherapeutic treatment.

Work-related treatment for major depressive disorder and incapacity to work: preliminary findings of a controlled, matched study.

The aim of this study was to compare the effectiveness of work-related cognitive-behavioral treatment (W-CBT) with that of cognitive-behavioral treatment as usual (CBT-AU) for employees on sick leave as a result of a major depressive disorder (MDD). We collected data for 26 matched outpatients at pre- and posttreatment, as well as at 1-year follow-up. Outcome measures were the days of incapacity to work (DIW) as well as self-report measures (Beck Depression Inventory [BDI], Symptom Checklist 90-R [GSI], Life Satisfaction Questionnaire [FLZ]). We analyzed data with hierarchical linear modeling in a 2-level model. Therapy effects were defined in 3 ways: effect size (ES), response (based on the reliable change index), and remission compared with the general population's symptom level. The DIW were reduced significantly after both types of treatment, but employees showed even fewer DIW after W-CBT. At follow-up, significantly more employees were working as a result of W-CBT than with CBT-AU. Significant improvements on scores of self-rating measures corresponded with moderate-to-large effect sizes for both treatment types. Approximately 2 thirds of the treated employees were categorized as unimpaired on BDI scores at posttreatment and at follow-up. At least 1 half of the employees were classified as unimpaired on GSI scores at both assessment points. In future research, a randomized controlled trial should be conducted using a larger sample size to investigate the impact of moderators (e.g., employees at different branches of the company). Findings provided support for using common CBT techniques to enhance return to work without losing expected improvements at the symptom level.

Population-based cost-offset estimation for the treatment of borderline personality disorder: projected costs in a currently running, ideal health system.

Borderline personality disorder (BPD) is considered one of the most expensive mental disorders in terms of direct and indirect costs. The aim of this study was to carry out a cost-offset estimation of disorder-specific psychotherapy for BPD at the population level. The study investigated whether the possible financial benefits of dialectical behavior therapy outweigh the therapy costs, assuming a currently running, ideal health system, and whether the estimated cost-benefit relationships change depending upon the number of patients willing to be treated. A formula was elaborated that allows the user to calculate cost-benefit relationships for various conservative or progressive scenarios, with different stages of individuals' willingness to be treated (10%-90%). The possible costs and benefits of BPD-related treatment were evaluated using a 12-month, prevalence-based approach. The annual costs for untreated BPD were 8.69 billion EUR annually. The cost-benefit relationship for the treatment remained constant at 1.52 for all scenarios, implying that for each EUR invested, 1.52 EUR can be gained within one year, independent of the willingness to be treated. Additional intangible benefits were calculated with the aid of Quality-Adjusted Life Years. Findings suggest that BPD-related treatment might well be efficient at the population level.