Abstract
BackgroundA high proportion of individuals admitted to specialist secure hospital services for treatment of personality disorder do not complete treatment. Non-completion has been associated with poorer treatment outcomes and increased rates of recidivism and hospital readmission, when compared with individuals who do complete treatment or who do not receive treatment at all.AimsIn this study, we sought to determine the economic consequences of non-completion of treatment, using case study data from a secure hospital sample. Both health and criminal justice service perspectives were taken into account.MethodsData were collected from a medium secure hospital personality disorder unit. A probabilistic decision-analytic model was constructed, using a Markov cohort simulation with 10,000 iterations. The expected cost differential between those who do and those who do not complete treatment was estimated, as was the probability of a cost differential over a 10-year post-admission time horizon.ResultsOn average, in the first 10 years following admission, those who do not complete treatment go on to incur £52,000 more in costs to the National Health Service and criminal justice system than those who complete treatment. The model estimates that the probability that non-completers incur greater costs than completers is 78%.ConclusionIt is possible that an improvement in treatment completion rates in secure hospital personality disorder units would lead to some cost savings. This might be achievable through better selection into treatment or improved strategies for engagement and retention. Our study highlights a financial cost to society of individuals discharged from secure hospital care when incompletely treated. We suggest that it could, therefore, be useful for secure hospitals to introduce routine monitoring of treatment completion. © 2013 The Authors. Criminal Behaviour and Mental Health published by John Wiley & Sons, Ltd.
Highlights
Personality disorders affect many people, with an estimated 2.5 million cases in England, and a contribution to healthcare costs of around £8bn each year (McCrone et al, 2008)
The treatment completion rate was 25%; slightly lower than that found in a review of previous studies (McMurran et al, 2010)
Our study was the first to evaluate the economic consequences of noncompletion of treatment for personality disorder, and one of very few that have used modelling techniques
Summary
Personality disorders affect many people, with an estimated 2.5 million cases in England, and a contribution to healthcare costs of around £8bn each year (McCrone et al, 2008). Rates of non-completion of treatments for personality disorders have been found to vary, averaging around 37% (McMurran et al, 2010). Patients who do not complete treatment for borderline personality disorder, for example, have been found to spend three times longer in hospital than treatment completers (Webb and McMurran, 2009). Non-completers of an inpatient treatment programme for legally detained personality disordered offenders committed more offences in a 5-year follow-up period than did completers (McCarthy and Duggan, 2010). The primary objective of this study was to determine the likelihood that, and extent to which, personality disordered offenders who complete treatment – ‘treatment completers’ – and those who do not complete treatment – ‘non-completers’ – go on to incur different costs to society following discharge. A secondary objective was to demonstrate the feasibility of using decisionanalytic modelling techniques in the evaluation of personality disorder services
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