Outpatient Psychotherapy Improves Symptoms and Reduces Health Care Costs in Regularly and Prematurely Terminated Therapies.

Uwe Altmann,Anna Zimmermann,Andrea Fembacher,Bernhard Strauß,Irmgard Pfaffinger,Désirée Thielemann,Andrés Steffanowski,Ellen Bruckmeier

doi:10.3389/fpsyg.2018.00748

Abstract

Background: In view of a shortage of health care costs, monetary aspects of psychotherapy become increasingly relevant. The present study examined the pre-post reduction of impairment and direct health care costs depending on therapy termination (regularly terminated, dropout with an unproblematic reason, and dropout with a quality-relevant reason) and the association of symptom and cost reduction.Methods: In a naturalistic longitudinal study, we examined a disorder heterogeneous sample of N = 584 outpatients who were either treated with cognitive-behavioral, psychodynamic, or psychoanalytic therapy. Depression, anxiety, stress, and somatization were assessed with the Patient Health Questionnaire (PHQ). Annual amounts of inpatient costs, outpatient costs, medication costs, days of hospitalization, work disability days, utilization of psychotherapy, and utilization of pharmacotherapy 1 year before therapy and 1 year after therapy were provided by health care insurances. Symptom and cost reduction were analyzed using t-tests. Associations between symptom and cost reduction were examined using partial correlations and hierarchical linear models.Results: Patients who terminated therapy regularly showed the largest symptom reduction (d = 0.981–1.22). Patients who dropped out due to an unproblematic reason and patients who terminated early due to a quality-relevant reason showed significant but small effects of symptom reductions (e.g., depression: d = 0.429 vs. d = 0.366). For patients with a regular end and those dropping out due to a quality-relevant reason, we observed a significant reduction of work disability (diff in % of pre-test value = 56.3 vs. 42.9%) and hospitalization days (52.8 vs. 35.0%). Annual inpatient costs decreased in the group with a regular therapy end (31.5%). Furthermore, reduction of symptoms on the one side and reduction of work disability days and psychotherapy utilization on the other side were significant correlated (r = 0.091–0.135).Conclusion: Health care costs and symptoms were reduced in each of the three groups. The average symptom and cost reduction of patients with a quality-relevant dropout suggested that not each dropout might be seen as therapy failure.

Highlights

Health care expenditures are large and are increasing steadily
The present study is based on the project “Quality Assurance in Ambulatory Psychotherapy in Bavaria” (QS-PSY-BAY) which examined the effect of outpatient psychotherapy on symptom reduction and cost reduction under naturalistic conditions (Strauss et al, 2015)
Cost data and questionnaire data come from two separate data sources: About 79,000 individuals were randomly selected by health insurant funds using the database of all insured individuals of these funds treated with outpatient psychotherapy in the reference quarter

Summary

Introduction

Health care expenditures are large and are increasing steadily. In Germany, for example, 11.3% of the gross domestic product go into health care expenditures; these increased by 3.8% from 2015 to 2016 (Statistisches Bundesamt, 2018). Since mental disorders are widespread, monetary aspects of these disorders (e.g., work disability days) and their treatments become increasingly relevant (Wunsch et al, 2013; Castelnuovo et al, 2016). An increase of medical service contacts, costs, hospitalization days, and work disability days during the 2 years before inpatient (Zielke, 1993) as well as outpatient psychotherapy (Kraft et al, 2004, 2006; Altmann et al, 2016). Mental disorders are commonly associated with long-term costs. Contrary to a decrease of sick leave in general, several German health insurance companies noticed an increase of sick leave caused by mental disorders by 30–50% (Bundespsychotherapeutenkammer, 2011). In view of a shortage of health care costs, monetary aspects of psychotherapy become increasingly relevant. The present study examined the pre-post reduction of impairment and direct health care costs depending on therapy termination (regularly terminated, dropout with an unproblematic reason, and dropout with a quality-relevant reason) and the association of symptom and cost reduction

Methods

Results

Conclusion