The burden of disease in patients eligible for mentalization-based treatment (MBT): quality of life and costs.

Elisabeth M P Laurenssen,Jack J M Dekker,Hester V Eeren,Dieuwertje Westra,Jaap Peen,Jan J V Busschbach,Martijn J Kikkert

doi:10.1186/s12955-016-0538-z

Abstract

BackgroundMentalization-Based Treatment (MBT) is a promising, though expensive treatment for severely ill patients with Borderline Personality Disorder (BPD). A high burden of disease in terms of quality of life (QoL) and life years lost can be a reason to prioritize mental health interventions, and specifically for BPD patients. Moreover, when the societal costs of the illness are high, spending resources on high treatment costs would be more easily legitimized. Therefore, the purpose of this study was to calculate the burden of disease of BPD patients eligible for MBT.MethodsThe 403 patients included in this study were recruited from two mental health care institutes in the Netherlands. All patients were eligible for MBT. Burden of disease consisted of QoL, measured with the EuroQol EQ-5D-3L, and costs, calculated using the Trimbos and Institute for Medical Technology Assessment Questionnaire for Costs Associated with Psychiatric Illness.ResultsThe mean QoL index score was .48. The mean total costs in the year prior to treatment were €16,879 per patient, of which 21 % consisted of productivity costs.ConclusionsThe burden of disease in BPD patients eligible for MBT is high, which makes it more likely that society is willing to invest in treatment for these patients. However, this finding should not be interpreted as a license to unlimitedly use resources to reimburse treatment for severe BPD patients, as these findings do not provide any information on the effectiveness of MBT or other available treatment programs for BPD. The effectiveness of available treatments should be evident by studies on the effectiveness of the treatment itself and by comparing the effectiveness of these treatments to treatment as usual and to other treatment options for BPD patients.Trial registrationThe data on this paper came from two trials: NTR2175 and NTR2292.

Highlights

Mentalization-Based Treatment (MBT) is a promising, though expensive treatment for severely ill patients with Borderline Personality Disorder (BPD)
It is suggested that the EQ-5D-3 L may not be sensitive enough to reflect the impact of severe mental disorders, such as chronic schizophrenia and Personality disorder (PD) [54], the current study showed that these concerns are not justified for severe BPD patients in our study population
Given the low quality of life (QoL) and high societal burden we found in this study, an expensive treatment for severely ill BPD patients, such as MBT, can more be legitimized

Summary

Introduction

Mentalization-Based Treatment (MBT) is a promising, though expensive treatment for severely ill patients with Borderline Personality Disorder (BPD). A high burden of disease in terms of quality of life (QoL) and life years lost can be a reason to prioritize mental health interventions, and for BPD patients. The willingness to pay for such treatment programs tends to be higher than for patients having less severe health conditions [5] This relation between burden of disease and willingness to pay has been imbedded in economic theory, usually under the name ‘equity’ or ‘solidarity’ [6] and is tested in panels of policy makers and lay people [7,8,9]. People tend to put a high value on interventions for severe health conditions [5], and are more willing to allocate resources to treat those patients, they accept a higher cost-effectiveness ratio when patients suffer from a high burden in terms of QoL and costs [5]. For BPD patients in general, the QoL and societal costs are estimated in some earlier studies, on which we will elaborate first

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