A controlled treatment study of somatoform disorders including analysis of healthcare utilization and cost-effectiveness

J Psychosom Res. 2003 Apr;54(4):369-80. doi: 10.1016/s0022-3999(02)00397-5.


Objective: The purpose of this prospective study was to evaluate the effects of cognitive-behavioral treatment (CBT) on mental health status and healthcare utilization in patients with somatoform disorders (SFD) of a specialized tertiary care center.

Methods: According to DSM-IV interviews, 54 patients had somatization disorder (SD), 51 abridged somatization syndrome (SSI-8) and 67 other defined SFD. A clinical non-SFD comparison group consisted of 123 patients. Treatment effects were controlled against the waiting list. Cost calculations for the 2-year periods before and after treatment were based on medical and billing records from health insurance companies.

Results: The SFD patients improved significantly with respect to physical symptom distress, health anxieties, dysfunctional beliefs towards body and health, depression and psychosocial functioning. Their outpatient plus inpatient charges during the 2 years prior to treatment were about 2.2-fold higher than for average patients of the health system. At the 2-year follow-up, we found treatment-related cost offset of 382 (-24.5%) for outpatient and 1098 (-36.7%) for inpatient care. Indirect socioeconomic costs due to days lost from work decreased by 6702 (-35.3%). Per patient savings of 32,174 (-63.9%) were found in a subgroup of somatizing high-utilizers.

Conclusion: The results encourage including treatment strategies to reduce somatoform illness behavior into clinical practice.

Publication types

  • Clinical Trial
  • Controlled Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Cognitive Behavioral Therapy / economics*
  • Cognitive Behavioral Therapy / methods*
  • Cost-Benefit Analysis
  • Depression / diagnosis
  • Depression / economics
  • Depression / therapy
  • Diagnostic and Statistical Manual of Mental Disorders
  • Female
  • Follow-Up Studies
  • Health Services / economics*
  • Health Services / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Sampling Studies
  • Socioeconomic Factors
  • Somatoform Disorders / diagnosis
  • Somatoform Disorders / economics*
  • Somatoform Disorders / therapy*
  • Surveys and Questionnaires