A controlled treatment study of somatoform disorders including analysis of healthcare utilization and cost-effectiveness

Abstract

Objective: The purpose of this prospective study was to evaluate the effects of cognitive-behavioral treatment (CBT) on mental health status and healthcare utilization in patients with somatoform disorders (SFD) of a specialized tertiary care center. Methods: According to DSM-IV interviews, 54 patients had somatization disorder (SD), 51 abridged somatization syndrome (SSI-8) and 67 other defined SFD. A clinical non-SFD comparison group consisted of 123 patients. Treatment effects were controlled against the waiting list. Cost calculations for the 2-year periods before and after treatment were based on medical and billing records from health insurance companies. Results: The SFD patients improved significantly with respect to physical symptom distress, health anxieties, dysfunctional beliefs towards body and health, depression and psychosocial functioning. Their outpatient plus inpatient charges during the 2 years prior to treatment were about 2.2-fold higher than for average patients of the health system. At the 2-year follow-up, we found treatment-related cost offset of 382 € (−24.5%) for outpatient and 1098 € (−36.7%) for inpatient care. Indirect socioeconomic costs due to days lost from work decreased by 6702 € (−35.3%). Per patient savings of 32,174 € (−63.9%) were found in a subgroup of somatizing high-utilizers. Conclusion: The results encourage including treatment strategies to reduce somatoform illness behavior into clinical practice.