Cost-effectiveness of brief psychodynamic-interpersonal therapy in high utilizers of psychiatric services

Arch Gen Psychiatry. 1999 Jun;56(6):519-26. doi: 10.1001/archpsyc.56.6.519.


Background: It is known that a small number of patients with mental health problems have chronic disorders and account for a disproportionate amount of mental health costs. This randomized controlled trial evaluated the cost-effectiveness of psychodynamic-interpersonal therapy vs treatment as usual in patients with mental health problems who were unresponsive to usual treatment.

Method: Subjects (N = 110) with nonpsychotic disorders unresponsive to 6 months of routine specialist mental health treatment were enrolled in a randomized controlled trial. Sixty-three percent were women, the mean age was 41.4 years, the median duration of illness was 5 years, 68% were unemployed or receiving state benefits because of illness, and 75.5% had a depressive illness. Intervention patients received 8 weekly sessions of psychodynamic-interpersonal psychotherapy. Control patients received usual care from their psychiatrist. Outcome measures included ratings of psychological distress and health status and a detailed economic evaluation. Analysis was conducted on an intent-to-treat basis.

Results: Subjects randomized to psychotherapy had a significantly greater improvement than controls in psychological distress and social functioning 6 months after the trial. Baseline treatment costs were similar for both groups. Subjects who received psychotherapy showed significant reductions in the cost of health care utilization in the 6 months after treatment compared with controls. The extra cost of psychotherapy was recouped within 6 months through reductions in health care use.

Conclusion: These preliminary findings suggest that brief psychodynamic-interpersonal therapy may be cost-effective relative to usual care for patients with enduring nonpsychotic symptoms who are not helped by conventional psychiatric treatment.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cost-Benefit Analysis
  • Depressive Disorder / economics
  • Depressive Disorder / psychology
  • Depressive Disorder / therapy
  • England
  • Female
  • Health Care Costs
  • Health Services / statistics & numerical data
  • Health Status
  • Humans
  • Male
  • Mental Disorders / economics
  • Mental Disorders / psychology
  • Mental Disorders / therapy*
  • Prospective Studies
  • Psychiatric Status Rating Scales / statistics & numerical data
  • Psychotherapy, Brief / economics*
  • Psychotherapy, Brief / methods
  • Quality of Life
  • Treatment Outcome