Borderline Personality Disorder (BPD) is one of the more prevalent mental disorders in the Netherlands; <1% of the population suffered from BPD in 2010. It is a psychiatric condition that is influenced by impulsivity, instability, and the incapability of maintaining relationships. Dialectial Behavior Therapy can lead to superior outcomes compared to standard of care treatments. Moreover, inpatient DBT compared to outpatient DBT, leads to significantly better treatment outcomes in at least one of the outcome variables.
This study is a prospective randomized controlled trial. It consists of a two-by- five repeated measures factorial design; which consists of the intervention group comprised of the individuals receiving short-term inpatient DBT, and the control group where individuals receive standard DBT. Five time points were measured: pre- treatment, 12 weeks, 24 weeks, 36 weeks, and 52 weeks. No blinding took place during the study.
This study is one of the first cost-effectiveness analyses comparing short-term inpatient DBT to outpatient DBT for severe cases of BPD. The higher costs and higher effects in the short-term DBT group, compared to outpatient DBT, lead to a bootstrapped ICER of 112,300€/QALY. Short-term inpatient DBT was more expensive than outpatient DBT, mainly due to the admission costs for inpatient treatment. Thus, at a consensus threshold of 80,000€/QALY, acceptance of short-term inpatient DBT is not to be expected for this particular condition and study population and thus cannot be considered the preferred option.