The effects of long-term psychoanalytic treatment on healthcare utilization and work impairment and their associated costs
Berghout, C. C., Zevalkink, J., & Hakkaart-Van Roijen, L. (2010). The effects of long-term psychoanalytic treatment on healthcare utilization and work impairment and their associated costs. Journal of Psychiatric Practice 16, (4), 209-216.
De Maat, S., Philipszoon, F., Schoevers, R., Dekker, J., & De Jonghe, F. (2007). Costs and benefits of long-term psychoanalytic therapy: Changes in health care use and work impairment. Harvard Review Psychiatry, 15, 289-300.
Long-term psychoanalytic treatment is perceived as an expensive ambulatory treatment for mental illnesses. However, there are indications that psychoanalytic treatment can result in cost savings in the long term. In this study, the effects of long-term psychoanalytic treatment on healthcare utilization and work impairment were investigated and the associated societal costs were calculated. The authors assessed healthcare utilization and work impairment of patients before, during, and after long-term psychoanalytic treatment (N = 231). The results show that the difference in total costs associated with healthcare utilization and work impairment between pre- and post-treatment was €2,444 (U.S.$3,070 using average exchange rates for 2006, the year for which these data were calculated) per person per year. Two years after treatment termination, these cost savings had increased to €3,632 ($4,563) per person per year. This indicates that one can expect decreased consumption of medical care and higher work productivity right after psychoanalytic treatment, but also that long-term psychoanalytic treatment can generate economic benefits in the long run. However, one cannot conclude that all invested costs will be earned back eventually. More research is needed on the cost-effectiveness of psychoanalytic treatment.
Of course, long-term psychoanalytic treatment should be considered beneficial not only because it can reduce costs associated with healthcare utilization and work impairment. The primary goal of psychotherapy is to improve a patient’s psychological state, with reductions in societal costs being a secondary goal. The authors emphasize that indirect cost savings should not be a prerequisite for funding of psychotherapy. A cost-effective treatment is not necessarily cheap or cost-saving, but rather is characterized by clinically significant psychological and/or societal gains that make the invested costs worthwhile. It is recommend that state-of-the-art cost-effectiveness analyses be conducted in future studies.
Prof. Caspar C. Berghout
Department of Research and Quality Assurance, Netherlands Psychoanalytic Institute, PO; Box 7031, 1007 JA Amsterdam