Health service use costs by personality disorder following specialist and nonspecialist treatment: a comparative study

The impact of specialist psychosocial treatment on health service use costs by patients with personality disorder is not yet sufficiently documented. In this prospective study we compare patterns of health service costs by three groups of people with personality disorder treated in a hospital-based program (IPP), a step down program (SDP), and a general psychiatric program (GPP). Total service use costs at follow up, compared with intake costs, showed that significantly higher savings were achieved by SDP and IIP compared with GPP. Cost reductions in SDP were significantly greater than in IPP. Significant cost reductions were found between treatment programs in social worker and community psychiatric nursing and psychotherapy. The cost-effectiveness of the two specialist treatment programs was indicated by the significant association between total cost reduction and clinical outcome in GPP and IPP, but not in GPP. The effect of Major Depression and Borderline Personality Disorder on health service use alone and in combination was also investigated. The finding that Major Depression was found to be more significantly associated with higher health service use costs than Borderline Personality Disorder is discussed.