L Salvador-Carulla1, M Bendeck2, M Ferrer3, O Andión4, E Aragonès5, M Casas3. 1. Centre for Disability Research and Policy, Faculty of Health Sciences, Unit of Mental Health Policy, Brain and Mind Research Institute, The University of Sydney, Sydney, Australia. Electronic address: luis.salvador-carulla@sydney.edu.au. 2. InGenis Consulting Group, Barcelona, Spain. 3. Psychiatry Department, Hospital Universitari Vall d'Hebron, CIBERSAM, Barcelona, Spain; Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain. 4. Psychiatry Department, Hospital Universitari Vall d'Hebron, CIBERSAM, Barcelona, Spain; Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain; Institut de Neurociències, Universitat Autònoma de Barcelona, Barcelona, Spain. 5. Centre d'Atenció Primària de Constantí, Institut Català de la Salut, Catalonia, Spain, and Institut d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.
Abstract
INTRODUCTION: The available information on the cost of illness of Borderline Personality Disorder (BPD) is overtly insufficient for policy planning. Our aim was to estimate the costs of illness for BPD in Catalonia (Spain) for 2006. METHODS: This is a multilevel cross-design synthesis study combining a qualitative nominal approach, quantitative 'top-down' analysis of multiple health databases, and 'bottom-up' data of local surveys. Both direct and indirect costs have been estimated from a governmental and societal perspective. RESULTS: Estimated year-prevalence of BPD was 0.7% (41,921 cases), but only 9.6% of these cases were treated in the mental health system (4033 cases). The baseline of the total cost of BPD in Catalonia was 45.6 million€, of which 15.8 million€ (34.7%) were direct costs related to mental health care. The cost distribution was 0.4% in primary care; 4% in outpatient mental health care; 4.7% in hospitalisation; 0.7% in emergency care; and 24.9% in pharmacotherapy. Additionally, the cost of drug addiction treatment for persons with BPD was 11.2%; costs associated with sheltered employment were 23.9% and those of crime and justice were 9.7%. Indirect costs - including temporary sick leave and premature death (suicide) - represented 20.5% of total costs. The average annual cost per patient was 11,308€. CONCLUSIONS: An under-reporting of BPD was identified by the experts in all health databases and official registries. Most of the BPD costs were not related to mental health care. Amongst the direct cost categories, pharmacotherapy had the largest proportion despite the lack of specificity for BPD. This distribution of costs reinforces the idea of BPD complexity related to an inadequate and inefficient use of health resources.
INTRODUCTION: The available information on the cost of illness of Borderline Personality Disorder (BPD) is overtly insufficient for policy planning. Our aim was to estimate the costs of illness for BPD in Catalonia (Spain) for 2006. METHODS: This is a multilevel cross-design synthesis study combining a qualitative nominal approach, quantitative 'top-down' analysis of multiple health databases, and 'bottom-up' data of local surveys. Both direct and indirect costs have been estimated from a governmental and societal perspective. RESULTS: Estimated year-prevalence of BPD was 0.7% (41,921 cases), but only 9.6% of these cases were treated in the mental health system (4033 cases). The baseline of the total cost of BPD in Catalonia was 45.6 million€, of which 15.8 million€ (34.7%) were direct costs related to mental health care. The cost distribution was 0.4% in primary care; 4% in outpatient mental health care; 4.7% in hospitalisation; 0.7% in emergency care; and 24.9% in pharmacotherapy. Additionally, the cost of drug addiction treatment for persons with BPD was 11.2%; costs associated with sheltered employment were 23.9% and those of crime and justice were 9.7%. Indirect costs - including temporary sick leave and premature death (suicide) - represented 20.5% of total costs. The average annual cost per patient was 11,308€. CONCLUSIONS: An under-reporting of BPD was identified by the experts in all health databases and official registries. Most of the BPD costs were not related to mental health care. Amongst the direct cost categories, pharmacotherapy had the largest proportion despite the lack of specificity for BPD. This distribution of costs reinforces the idea of BPD complexity related to an inadequate and inefficient use of health resources.
Authors: Andrew M Chanen; Katie Nicol; Jennifer K Betts; Gary R Bond; Cathrine Mihalopoulos; Henry J Jackson; Katherine N Thompson; Martina Jovev; Hok Pan Yuen; Gina Chinnery; Judith Ring; Kelly Allott; Louise McCutcheon; Ashleigh P Salmon; Eoin Killackey Journal: Trials Date: 2020-06-26 Impact factor: 2.279