Cost-offset effect of psychotherapy in reducing medical health service utilization

Kraft, S., Puschner, B., Lambert, M. J., & Kordy, H. (2006). Medical utilization and treatment outcome in mid- and long-term outpatient psychotherapy. Psychotherapy Research, 16 (2), 241-249.


This study examined service use and its relation to outcome in people receiving outpatient psychotherapy with a special focus on the possible cost-offset effect of psychotherapy in reducing medical health service utilization.


Between September 1998 and February 2000 all adult insurees of a large private insurance company (“Deutsche Krankenversicherung”, DKV) who applied for reimbursement of their outpatient psychotherapy were asked to participate in the TRANS-OP study (see Open Door Review…). Due to the considerable time and effort for the collection and analysis of service use data, a randomized subsample of 200 participants who had applied either for cognitive behavioral therapy (CBT, N=100) or psychodynamic psychotherapy (PD, N=100), was drawn of the original sample (N=939). Medical utilization data were analyzed only for participants who had returned at least the baseline questionnaire (N=176).


Information about medical utilization (outpatient and inpatient treatments) was made available by the DKV via computerized, aggregated records of insurance claims. Psychological distress was assessed with the German adaptation (EB-45; Lambert, Hannöver, Nisslmüller, Richard, &Kordy, 2002) of the Outcome Questionnaire-45 (OQ-45.2; Lambert et al., 1996). Somatic distress was measured with the GiessenerComplaints Questionnaire (GBB-24; Brähler&Scheer,1995).


Mean medical costs continually increased before the start of outpatient psychotherapy and decreased thereafter. This pattern was more pronounced for hospital days, with a sharp decline immediately after the start of treatment. Medical costs during 6 months decreased  from 2,183.36 € (SD=/2491.29) at start of psychotherapy to 1,609.44 € (SD=1,951.62) two years later (26.3%). During the same time, hospital days showed a 78.7% decrease from  3.33 (SD=10.35) to 0.71 (SD=4.11). However, these differences were not statistically significant.

Improvement in somatic well-being within the 18 months after start of therapy was significantly related to a reduction in medical costs, even when controlling for pretreatment medical costs. Furthermore, the reduction in health care costs was somewhat larger in younger patients, and cost reduction was somewhat larger in patients with fewer sessions. No difference in reduction of medical care utilization was found between the two forms of psychotherapy.


This is one of the few studies which examined cost offset after mid- and long-term outpatient psychotherapy. To our knowledge, by then it was the first that analyzed the association of cost offset and mental health treatment outcome, and it was the only European study besides Sandell et al. (2001) in which direct health care costs, and not only hospital or disability days, were obtained from objective data sources (i.e., insurance claims).


Dr. Hans Kordy

Center for Psychotherapy Research, Heidelberg University, Heidelberg, Germany.