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Online ISSN: 1099-176X    Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 15, Issue 1, 2012. Pages: 13-23
Published Online: 30 March 2012

Copyright © 2012 ICMPE.


 

The Cost-Effectiveness of Short-Term Psychodynamic Psychotherapy and Solution-Focused Therapy in the Treatment of Depressive and Anxiety Disorders during a One-year Follow-up

Timo Maljanen,1 Päivi Paltta,1 Tommi Härkänen,2 Esa Virtala,2 Olavi Lindfors,3 Maarit A. Laaksonen,2 Paul Knekt,1,2 and the Helsinki Psychotherapy Study Group1-5

1Social Insurance Institution, Helsinki, Finland
2National Institute for Health and Welfare, Helsinki, Finland
3Biomedicum Helsinki, Helsinki, Finland
4Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
5Rehabilitation Foundation, Helsinki, Finland

* Correspondence to: Timo Maljanen, Social Insurance Institution, PO Box 450, 00101 Helsinki, Finland.
Tel.: +358-20-6341 967
Fax: +358-20-6341 700
E-mail: timo.maljanen@kela.fi

Source of Funding: This study was funded by the Social Insurance Institution, Finland. The Institution had no further role in study design; in the collection, analysis or interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.

Abstract

The aim of this study, based on the Helsinki Psychotherapy Study data, was to compare the costs and effectiveness of short-term psychodynamic psychotherapy (SPP) and solution-focused therapy (SFT) in the treatment of depressive and anxiety disorders during a one-year follow-up. A total of 101 patients were randomized to SPP and 97 to SFT. Psychiatric symptoms were assessed using the Beck Depression Inventory, the Hamilton Depression Rating Scale, the Symptom Check List Anxiety Scale and the Hamilton Anxiety Rating Scale. All four health indicators showed statistically significant reductions in psychiatric symptoms in both treatment groups. The differences between the groups were small and not statistically significant. The mean total health care costs due to mental disorders in the SPP group (1791 euros) were 16% smaller than in the SFT group but also this difference was nonsignificant. Thus no notable difference in the cost-effectiveness of these two therapies could be identified.

 

Background: Mood and anxiety disorders are characterized by a high and increasing prevalence, they cause a lot of costs and human suffering and there are many treatment options with differing costs. The benefits of identifying the treatments with the most favourable cost-effectiveness ratios can be substantial. However, the number of randomized trials where psychological treatments are compared with each other and where economic aspects, too, are taken into account is still relatively small.

Aim: To compare the cost-effectiveness of two short-term psychotherapies in the treatment of depressive and anxiety disorders during a one-year follow-up.

Methods: In the Helsinki Psychotherapy Study, 198 patients, who were 20--45 years of age and met DSM-IV criteria for anxiety or mood disorder, were randomized to short-term psychodynamic psychotherapy (SPP) or solution-focused therapy (SFT). Psychiatric symptoms were assessed at baseline and 4 times during the one-year follow-up from the start of therapy using the Beck Depression Inventory and the Symptom Check List Anxiety Scale, and 2 times using the Hamilton Depression Rating Scales and Hamilton Anxiety Rating Scales. Both direct costs (therapy sessions, outpatient visits, medication, inpatient care) and indirect costs (production losses due to work absenteeism, value of neglected household work, lost leisure time and unpaid help received) due to mental disorders were measured. Mean total costs were compared and incremental cost-effectiveness ratios analyzed.

Results: According to all 4 psychiatric outcome measures, symptoms of depression and anxiety were reduced statistically significantly in both therapy groups during the one-year follow-up. The relative changes were about the same size according to all four outcome measures. In both groups the reductions took place mainly in the first half of the follow-up. The reductions were somewhat greater with SPP, but the differences between the two groups were small and not statistically significant at any measurement point. The mean total direct costs were 1791 euros in the SPP group, being 346 euros (16%) lower than those of the SFT group, but this difference was not statistically significant either. Also the incremental cost-effectiveness ratio points calculated by 500 bootstrap iterations favoured SPP. The total indirect costs in the SPP group were, in contrast to direct costs, higher than those in the SFT group, but, again, the difference was not statistically significant.

Limitations: The generalization of our results may be weakened by the fact that the patients included in our study were relatively young, and the follow-up period was restricted to one year.

Implications: This study suggests that there are no notable differences in cost-effectiveness between SPP and SFT. If one were obliged to choose between these two therapies our results would support the choice of SPP. However, more research with extensive data about both costs and effectiveness, compiled over a period longer than one year, are needed before any firm conclusions can be drawn about the cost-effectiveness of the two therapies compared in this study.


Received 16 June 2010; accepted 18 February 2012

Copyright 2012 ICMPE