Economic Evaluation of Day Hospital Versus Intensive Outpatient Mentalization-Based Treatment Alongside a Randomized Controlled Trial With 36-Month Follow-Up

Matthijs Blankers*, Maaike L. Smits, Dine J. Feenstra, Eva K. Horn, Jan Henk Kamphuis, Dawn L. Bales, Zwaan Lucas, Melissa G.A. Remeeus, Jack J.M. Dekker, Roel Verheul, Jan J.V. Busschbach, Patrick Luyten

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Mentalization-based treatment (MBT) has demonstrated robust effectiveness in the treatment of borderline personality disorder (BPD) in both day-hospital (MBT-DH) and intensive outpatient MBT (MBT-IOP) programs. Given the large differences in intensity and associated treatment costs, there is a need for studies comparing their cost-effectiveness. A health economic evaluation of MBT-DH versus MBT-IOP was performed alongside a multicenter randomized controlled trial with a 36-month follow-up. In three mental health-care institutions in the Netherlands, 114 patients were randomly allocated to MBT-DH (n = 70) or MBT-IOP (n = 44) and assessed every 6 months. Societal costs were compared with quality-adjusted life years (QALYs) gained and the number of months in remission over 36 months. The QALY gains over 36 months were 1.96 (SD =.58) for MBT-DH and 1.83 (SD =.56) for MBT-IOP; the respective number of months in remission were 16.0 (SD = 11.5) and 11.1 (SD = 10.7). Societal costs were e106,038 for MBT-DH and e91,368 for MBT-IOP. The incremental cost for one additional QALY with MBT-DH compared with MBT-IOP was e107,000. The incremental cost for 1 month in remission was almost e3000. Assuming a willingness-to-pay threshold of e50,000 for a QALY, there was a 33% likelihood that MBT-DH is more costeffective than MBT-IOP in terms of costs per QALY. Although MBT-DH leads to slightly more QALYs and remission months, it is probably not cost-effective when compared with MBT-IOP for BPD patients, as the small additional health benefits in MBT-DH did not outweigh the substantially higher societal costs.

Original languageEnglish
Pages (from-to)207-215
Number of pages9
JournalPersonality Disorders: Theory, Research, and Treatment
Issue number2
Early online date30 Jun 2022
Publication statusPublished - Mar 2023

Bibliographical note

Funding Information:
Matthijs Blankers and Maaike L. Smits are joint first authors. This work was supported in part by a grant from ZonMw (Grant 171202012). The funder of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of the report. The authors thank all research assistants for collecting the data. The authors are also most grateful to the patients who participated in this study. Patrick Luyten and Dawn L. Bales have been involved in the training and dissemination of mentalization-based treatment. The other authors declare that they have no competing interests. Data and code are not publicly available. All data requests should be submitted to Maaike L. Smits for consideration. Access to coded data and code might be granted following such requests depending on purpose.

Publisher Copyright:
© 2022 American Psychological Association


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