Citation

Botham J, Clark A, Steare T, Stuart R, Oram S, Lloyd-Evans B, Jeynes T, Broeckelmann E, Crawford M, Johnson S, Simpson A, McCrone P. BJPsych Open 2021; 7(6).

Copyright

(Copyright © 2021, Royal College of Psychiatrists)

DOI

10.1192/bjo.2021.1043

PMID

unavailable

Abstract

Background Diagnoses of personality disorder are prevalent among people using community secondary mental health services. Identifying cost-effective community-based interventions is important when working with finite resources. Aims To assess the cost-effectiveness of primary or secondary care community-based interventions for people with complex emotional needs who meet criteria for a diagnosis of personality disorder to inform healthcare policy-making.

METHOD Systematic review (PROSPERO: CRD42020134068) of databases. We included economic evaluations of interventions for adults with complex emotional needs associated with a diagnosis of personality disorder in community mental health settings published before 18 September 2019. Study quality was assessed using the CHEERS statement.

RESULTS Eighteen studies were included. The studies mainly evaluated psychotherapeutic interventions. Studies were also identified that evaluated altering the setting in which care was delivered and joint crisis plans. No strong economic evidence to support a single intervention or model of community-based care was identified.

CONCLUSIONS Robust economic evidence to support a single intervention or model of community-based care for people with complex emotional needs is lacking. The strongest evidence was for dialectical behaviour therapy, with all three identified studies indicating that it is likely to be cost-effective in community settings compared with treatment as usual. More robust evidence is required on the cost-effectiveness of community-based interventions on which decision makers can confidently base guidelines or allocate resources. The evidence should be based on consistent measures of costs and outcomes with sufficient sample sizes to demonstrate impacts on these. Copyright © The Author(s), 2021.

Language: en

Keywords

adult; human; systematic review; female; male; Review; decision making; psychotherapy; suicide attempt; Personality disorder; psychoeducation; primary medical care; mental health care; personality disorder; health care quality; community care; automutilation; cognitive therapy; practice guideline; emotion; Cost-effectiveness; problem solving; community mental health; cost effectiveness analysis; health care need; dialectical behavior therapy; quality adjusted life year; economic evaluation; stepped care; Health economics; secondary health care; schema therapy; mentalization-based treatment; Community care; nidotherapy; Out-patient treatment