Effects and cost-effectiveness analysis of inpatient treatment for somatoform disorders

Abstract

Patients with somatoform disorders represent an expensive problem group of the healthcare system characterized by inappropriately high medical costs. This paper describes a controlled inpatient treatment study using a cognitive-behavioral approach. The aim of this treatment program was to improve the patients' symptomatology and their psychosocial functioning, as well as reducing unnecessary medical costs. We treated 172 patients with somatoform disorders (DSM-IV) and compared them with 262 patients of a waiting control list. An additional control group consisted of 123 patients with other mental disorders. Direct and indirect illness-related costs for the two-year periods before and after treatment were re-calculated using objective data provided by the health insurance companies. The results show a marked improvement in the areas of bodily complaints, health anxieties, dysfunctional beliefs towards body and health, depression and psychosocial impairments. The medical costs in the post-treatment period decreased by 1,098 euro (-36.7 %) for inpatient and 382 euro (-24.5 %) for outpatient treatments. Indirect costs due to days lost from work were 6,702 euro (-35.3 %) lower than during the two-years before treatment. The treatment costs had amortized after 21.5 months. We identified a subgroup of high-utilizing somatoform patients for which per patient savings of 32,174 euro (-63.9 %) were found. These results confirm that the cognitive-behavioral approach is effective in improving complaints as well as reducing the health-economical burden of somatoform disorders.