Hostname: page-component-8448b6f56d-jr42d Total loading time: 0 Render date: 2024-04-18T23:19:57.269Z Has data issue: false hasContentIssue false
  • English
  • Français

Cost of borderline personality disorder in Catalonia (Spain)

Published online by Cambridge University Press:  15 April 2020

L. Salvador-Carulla ,
M. Bendeck ,
M. Ferrer ,
Ó. Andión ,
E. Aragonès  and
M. Casas
L. Salvador-Carulla*
Affiliation:
Centre for Disability Research and Policy, Faculty of Health Sciences, Unit of Mental Health Policy, Brain and Mind Research Institute, The University of Sydney, Sydney, Australia
M. Bendeck
Affiliation:
InGenis Consulting Group, Barcelona, Spain
M. Ferrer
Affiliation:
Psychiatry Department, Hospital Universitari Vall d’Hebron, CIBERSAM, Barcelona, Spain Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
Ó. Andión
Affiliation:
Psychiatry Department, Hospital Universitari Vall d’Hebron, CIBERSAM, Barcelona, Spain Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain Institut de Neurociències, Universitat Autònoma de Barcelona, Barcelona, Spain
E. Aragonès
Affiliation:
Centre d’Atenció Primària de Constantí, Institut Català de la Salut, Catalonia, Spain, and Institut d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
M. Casas
Affiliation:
Psychiatry Department, Hospital Universitari Vall d’Hebron, CIBERSAM, Barcelona, Spain Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
*
*Corresponding author at: Centre for Disability Research and Policy, Faculty of Health Sciences, The University of Sydney, 75, East Street, Lidcombe, NSW 2141, Australia. Tel.: +61 2 9351 9231. E-mail address: luis.salvador-carulla@sydney.edu.au (L. Salvador-Carulla).
Get access

Abstract

Introduction

The available information on the cost of illness of Borderline Personality Disorder (BPD) is overtly insufficient for policy planning. Our aim was to estimate the costs of illness for BPD in Catalonia (Spain) for 2006.

Methods

This is a multilevel cross-design synthesis study combining a qualitative nominal approach, quantitative ‘top-down’ analysis of multiple health databases, and ‘bottom-up’ data of local surveys. Both direct and indirect costs have been estimated from a governmental and societal perspective.

Results

Estimated year-prevalence of BPD was 0.7% (41,921 cases), but only 9.6% of these cases were treated in the mental health system (4033 cases). The baseline of the total cost of BPD in Catalonia was 45.6 million €, of which 15.8 million € (34.7%) were direct costs related to mental health care. The cost distribution was 0.4% in primary care; 4% in outpatient mental health care; 4.7% in hospitalisation; 0.7% in emergency care; and 24.9% in pharmacotherapy. Additionally, the cost of drug addiction treatment for persons with BPD was 11.2%; costs associated with sheltered employment were 23.9% and those of crime and justice were 9.7%. Indirect costs – including temporary sick leave and premature death (suicide) – represented 20.5% of total costs. The average annual cost per patient was 11,308 €.

Conclusions

An under-reporting of BPD was identified by the experts in all health databases and official registries. Most of the BPD costs were not related to mental health care. Amongst the direct cost categories, pharmacotherapy had the largest proportion despite the lack of specificity for BPD. This distribution of costs reinforces the idea of BPD complexity related to an inadequate and inefficient use of health resources.

Keywords

Cost of illnessBorderline personality disorderQualitative researchQuantitative analysisHealth economics
Type
Original article
Information
European Psychiatry , Volume 29 , Issue 8 , October 2014 , pp. 490 - 497
Copyright
Copyright © Elsevier Masson SAS 2014

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association Practice guideline for the treatment of patients with Borderline Personality Disorder. Washington, DC: American Psychiatric Association; 2001.Google Scholar
Aragonès, E., Salvador-Carulla, L., López-Muntaner, J., Ferrer, M., Piñol, J.L.Registered prevalence of borderline personality disorder in the primary care databases. Gac Sanit 2013;27(2):171–174. [Epub 2012 Mar 7].CrossRefGoogle ScholarPubMed
Bendeck, M., Serrano-Blanco, A., García-Alonso, C., Bonet, P., Jordà, E., Sabes-Figuera, R.et al.An integrative cross-design synthesis approach to estimate the cost of illness: an applied case to the cost of depression in Catalonia. J Mental Health 2013;22(2):135–154.CrossRefGoogle ScholarPubMed
Bender, D.S., Dolan, R.T., Skodol, A.E., Sanislow, C.A., Dyck, I.R., McGlashan, T.H.et al.Treatment utilization by patients with personality disorders. Am J Psychiatry 2001;158(2):295–302.CrossRefGoogle ScholarPubMed
Cailhol, L., Jeannot, M., Rodgers, R., Guelfi, J., Perez-Diaz, F., Pham-Scottez, A.et al.Borderline personality disorder and mental healthcare service use among adolescents. J Pers Disord 2013;27(2):252–259.CrossRefGoogle ScholarPubMed
Chanen, A.M., Jackson, H.J., McCutcheon, L.K., Jovev, M., Dudgeon, P., Yuen, H.P.et al.Early intervention for adolescents with borderline personality disorder using cognitive analytic therapy: randomised controlled trial. Br J Psychiatry 2008;193:477–484.CrossRefGoogle ScholarPubMed
Chanen, A.M., Jovev, M., McCutcheon, L., Jackson, H.J., McGorry, P.D.Borderline personality disorder in young people and the prospects for prevention and early intervention. Curr Psychiatry Rev 2008;4:48–57.CrossRefGoogle Scholar
Dolan, B.M., Warren, F.M., Menzies, D., Norton, K.Cost-offset following specialist treatment of severe personality disorders. Psychiatr Bull 1996;20:413–417.CrossRefGoogle Scholar
Feenstra, D.J., Hutsebaut, J., Laurenssen, E.M., Verheul, R., Busschbach, J.J., Soeteman, D.I.The burden of disease among adolescents with personality pathology: quality of life and costs. J Pers Disord 2012;26(4):593–604.CrossRefGoogle ScholarPubMed
Fundació Pere Tarrés Bases i estudi per a l’elaboració d’un model d’inserció laboral per a les persones amb trastorn mental sever [Criteria and study for the development of a labour insertion model for persons with severe mental disorder]. Barcelona: Fundació Pere Tarres i Universitat Autònoma de Barcelona; 2010.Google Scholar
García-Altés, A., Ollé, J.M., Antoñanzas, F., Colom, J.The social cost of illegal drug consumption in Spain. Addiction 2002;97(9):1145–1153.CrossRefGoogle ScholarPubMed
Generalitat de Catalunya [Internet] Cost i càrrega de la depressió a Catalunya [Cost and burden of depression in Catalonia]. Barcelona: Departament de Salut. Generalitat de Catalunya; 2010. Available from: http://www20.gencat.cat/docs/canalsalut/Home%20Canal%20Salut/Professionals/Recursos/Estudis/13_salut_mental/documents/estudicostos2011.pdf [cited 2012 Feb 1].Google Scholar
Gibert, K., García-Alonso, C., Salvador-Carulla, L.Integrating clinicians, knowledge and data: expert-based cooperative analysis in healthcare decision support. Health Res Policy Syst 2010;8:28.CrossRefGoogle ScholarPubMed
Griffiths, M.Validity, utility and acceptability of borderline personality disorder diagnosis in childhood and adolescence: survey of psychiatrists. Psychiatr Bull 2011;35:19–22.Google Scholar
Grupo de trabajo de la guía de práctica clínica sobre trastorno límite de la personalidad. Fórum de Salud Mental y AIAQS - coordinadores. Guía de práctica clínica sobre trastorno límite de la personalidad [Clinical practice guideline on borderline personality disorder]. Agència d’Informació, Avaluació i Qualitat en Salut. Servei Català de la Salut. Pla Director de Salut Mental i Addiccions. Departament de Salut. Generalitat de Catalunya Barcelona Available from: 2011. http://www.gencat.cat/salut/depsan/units/aatrm/pdf/gpc_tlp_2011_completa.pdf [cited 2013 Apr 8].Google Scholar
Guina, H., Bohus, M., Klenast, T.[Primacy of out-patient treatment of borderline personality disorders]. Psychiatr Prax 2010;37:108–109.CrossRefGoogle Scholar
Gunderson, J.G., Stout, R.L., McGlashan, T.H., Shea, M.T., Morey, L.C., Grilo, C.M.et al.Ten-year course of borderline personality disorder: psychopathology and function from the Collaborative Longitudinal Personality Disorders study. Arch Gen Psychiatry 2011;68(8):827–837.CrossRefGoogle ScholarPubMed
Gustavsson, A., Svensson, B., Jacobi, F., Allgulander, C., Alonso, J., Beghi, E.et al.Cost of disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 2011;21(10):718–779.CrossRefGoogle ScholarPubMed
Haro, J.M., Pinto-Meza, A., Fernández, A., Ochoa, S., Serrano, A., Autonell, J.et al.Necesidades de atención en salud mental 1: Frecuencia y distribución. Trastornos mentales comunes en España [Mental health care needs 1: Frequency and distribution. Common mental disorders in Spain]. Monogr Psiquiatr 2008;20(1):15–21.Google Scholar
Koons, C.R., Robins, C.J., Tweed, J.L., Lynch, T.R., González, A.M., Morse, J.Q.et al.Efficacy of dialectical behavior therapy in women veterans with borderline personality disorder. Behav Ther 2001;32(2):371–390.CrossRefGoogle Scholar
Kvarstein, E.H., Arnevik, E., Halsteinli, V., Rø, F.G., Karterud, S., Wilberg, T.Health service costs and clinical gains of psychotherapy for personality disorders: a randomized controlled trial of day-hospital-based step-down treatment versus outpatient treatment at a specialist practice. BMC Psychiatry 2013;13:315.CrossRefGoogle Scholar
Leichsenring, F., Leibing, E., Kruse, J., New, A.S., Leweke, F.Borderline personality disorder. Lancet 2011;377:74–84.CrossRefGoogle ScholarPubMed
Lewin, S., Oxman, A.D., Lavis, J.N., Fretheim, A., Marti, S.G., Munabi-Babigumira, S.SUPPORT tools for evidence-informed policymaking in health 11: finding and using evidence about local conditions. Health Res Policy Syst 2009;7(Suppl. 1):S11.CrossRefGoogle ScholarPubMed
Linehan, M.M., Comtois, K.A., Murray, A.M., Brown, M.Z., Gallop, R.J., Heard, H.L.et al.Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry 2006;63(7):757–766.CrossRefGoogle ScholarPubMed
MacPhail, A.Nominal Group Technique: a useful method for working with young people. Br Educ Res J 2001;27(2):161–170.CrossRefGoogle Scholar
Magallón-Neri, E.M., Canalda, G., De la Fuente, J.E., Forns, M., García, R., González, E.et al.The influence of personality disorders on the use of mental health services in adolescents with psychiatric disorders. Compr Psychiatry 2012;53(5):509–515.CrossRefGoogle ScholarPubMed
Miller, A.L., Muehlenkamp, J.J., Jacobson, C.M.Fact or fiction: diagnosing borderline personality disorder in adolescents. Clin Psychol Rev 2008;28(6):969–981.CrossRefGoogle ScholarPubMed
Ministerio de Sanidad, Politica Social y Equidad. Documento de consenso de las comisiones de análisis de casos de personas con enfermedad mental sometidas a penas y medidas de seguridad [Consensus document of the commissions for analysis of cases of people with mental illness with sentences and subject to security measures] (15 de diciembre). Madrid: Subcomisión Penitenciaria (Secretaria General de IIPP). Comisión de Transversalidad de la Estrategia de Salud Mental del Ministerio de Sanidad Servicios Sociales e Igualdad; 2011.Google Scholar
Molina, R., Rubio, V., Pérez, A., Carrasco, J.Trastorno límite de la personalidad [Borderline personality disorder]. In: Roca, M. editor. Trastornos de la personalidad [Personality disorders] Barcelona: Ars Médica; 2003. p. 513–545.Google Scholar
New, A.S., Carpenter, D.M., Perez-Rodriguez, M.M., Ripoll, L.H., Avedon, J., Patil, U.et al.Developmental differences in diffusion tensor imaging parameters in borderline personality disorder. J Psychiatr Res 2013;47:1101–1109.CrossRefGoogle ScholarPubMed
NICE Borderline Personality Disorder: treatment and management. NICE clinical guideline 78. London (United Kingdom): National Institute for Health and Clinical Excellence (NICE); 2009.Google Scholar
Paris, J.Clinical trials of treatment for personality disorders. Psychiatr Clin North Am 2008;31(3):517–526.CrossRefGoogle ScholarPubMed
Paris, J.Chronic suicidality among patients with borderline personality disorder. Psychiatr Serv 2002;53(6):738–742.CrossRefGoogle ScholarPubMed
Pascual, J.C., Martín-Blanco, A., Soler, J., Ferrer, A., Tiana, T., Alvarez, E.et al.A naturalistic study of changes in pharmacological prescription for borderline personality disorder in clinical practice: from APA to NICE guidelines. Int Clin Psychopharmacol 2010;25(6):349–355.CrossRefGoogle ScholarPubMed
Rendu, A., Moran, P., Patel, A., Knapp, M., Mann, A.Economic impact of personality disorders in UK primary care attenders. Br J Psychiatry 2002;181:62–66.CrossRefGoogle ScholarPubMed
Rovira, J., Albarracin, G., Salvador, L., Rejas, J., Sánchez-Iriso, E., Cabasés, J.The cost of generalized anxiety disorder in primary care settings: results of the ANCORA study. Community Ment Health J 2012;48(3):372–383.CrossRefGoogle ScholarPubMed
Rubio, V., Pérez-Urdániz, A.Trastornos de la personalidad [Personality disorders]. Madrid: Elsevier; 2003.Google Scholar
Salvador-Carulla, L., Bendeck, M., Fernández, A., Alberti, C., Sabes-Figuera, R., Molina, C.et al.Costs of depression in Catalonia (Spain). J Affect Disord 2011;132:130–138.CrossRefGoogle Scholar
Salvador-Carulla, L., Costa-Font, J., Cabasés, J., McDaid, D., Alonso, J.Evaluating mental health care and policy in Spain. J Ment Health Policy Econ 2010;13(2):73–86.Google ScholarPubMed
Salvador-Carulla, L., Hernández-Peña, P.Economic context analysis in mental health care. Usability of health financing and cost of illness studies for international comparisons. Epidemiol Psychiatr Sci 2011;20(1):19–27.CrossRefGoogle ScholarPubMed
Salvador-Carulla, L., Martinez-Leal, R., Poole, M., Salinas-Perez, J.A., Tamarit, J., Garcia-Ibañez, J.et al.The mental health care gap in intellectual disabilities in Spain: impact analysis and knowledge-to-action plan. J Ment Health Policy Econ 2013;16(3):131–141.Google ScholarPubMed
Salvador-Carulla, L., Haro, J.M., Cabasés, J., Madoz, V., Sacristán, J.A., Vásquez-Barquero, J.L.et al.Service utilization and costs of first-onset schizophrenia in two widely diferring health service areas in North-East Spain. Acta Psychiatr Scand 1999;100:335–343.CrossRefGoogle ScholarPubMed
Soeteman, D.I., Hakkaart-van Roijen, L., Verheul, R., Busschbach, J.J.The economic burden of personality disorders in mental health care. J Clin Psychiatry 2008;69(2):259–265.CrossRefGoogle ScholarPubMed
Soeteman, D.I., Verheul, R., Delimon, J., Meerman, A.M., van den Eijnden, E., Rossum, B.V.et al.Cost-effectiveness of psychotherapy for cluster B personality disorders. Br J Psychiatry 2010;196(5):396–403.CrossRefGoogle ScholarPubMed
Torrens, M., Gilchrist, G., Domingo-Salvany, A., the psyCoBarcelona Group Psychiatric comorbidity in illicit drug users: substance-induced versus independent disorders. Drug Alcohol Depend 2011;113:147–156.CrossRefGoogle ScholarPubMed
van Asselt, A.D., Dirksen, C.D., Arntz, A., Severens, J.L.The cost of borderline personality disorder: societal cost of illness in BPD-patients. Eur Psychiatry 2007;22:354–361.CrossRefGoogle ScholarPubMed
van Asselt, A.D., Dirksen, C.D., Arntz, A., Severens, J.L.Difficulties in calculating productivity costs: work disability associated with borderline personality disorder. Value Health 2008;11(4):637–644.CrossRefGoogle ScholarPubMed
Winograd, G., Cohen, P., Chen, H.Adolescent borderline symptoms in the community: prognosis for functioning over 20 years. J Clin Psychology Psychiatry 2008;49:933–941.CrossRefGoogle ScholarPubMed
World Health Organization, mhGAP Intervention Guide for mental, neurological and substance use disorders in non-specialized health settings. Version 1.0. Geneva: WHO; 2010.Google Scholar
Young, D.W., Gunderson, J.G.Family images of borderline adolescents. Psychiatry 1995;58(2):164–172.CrossRefGoogle ScholarPubMed
Zanarini, M.C., Frankenburg, F.R., Hennen, J., Reich, D.B., Silk, K.R.The McLean Study of Adult Development (MSAD): overview and implications of the first six years of prospective follow-up. J Personal Disord 2005;19(5):505–523.CrossRefGoogle ScholarPubMed
Zanarini, M.C., Frankenburg, F.R., Hennen, J., Silk, K.R.Mental health service utilization by borderline personality disorder patients and Axis II comparison subjects followed prospectively for 6 years. J Clin Psychiatry 2004;65(1):28–36.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.