Browsing by Subject "Work Ability"

Abstract Faculty: Faculty of Social Sciences Program: Economics Study track: General Track Author: Julius Vili Henrik Rissanen Title: Comparing cost-effectiveness of short-term and long-term psychodynamic psychotherapies focusing on patients with depressive disorder and their work ability during a 5-year follow-up. Level: Master’s Thesis Month and Year: November 2021 Number of Pages: Keywords: Psychotherapy; cost-effectiveness; Work Ability; psychodynamic; randomized trial; Instructors: Roope Uusitalo, Lauri Sääksvuori, Costanza Biavaschi, Olavi Lindfors Deposited at: Helsingin Yliopiston kirjasto Other information: Abstract: Background: Mental health disorders pose significant burden to the society, for example, because of decreased work ability. Psychotherapy as one of the most important treatment methods also causes significant costs for the healthcare system. Putting effort into cost-effectiveness between the different therapy types can help promote better targeting of treatments and economic efficiency in society. Aims: Explore cost-effectiveness in improving work ability between short-term and long-term psychodynamic psychotherapy in patients with depression. Methods: The 192 depressive patients randomized to two psychotherapies of different lengths in the Helsinki Psychotherapy Study were measured in baseline and annually for five years. Work Ability Index (WAI) and Global Assessment of Functioning (GAF) as an effectiveness outcome measures were compared to the total direct costs with incremental cost-effectiveness ratios (ICER) between the treatments. Results: The total direct cost of short-term psychodynamic psychotherapy (SPP; €7,087) was significantly lower than for long-term psychodynamic psychotherapy (LPP; €19,959). The biggest explanatory factor between the cost of the treatments was protocol study therapy costs (SPP €1304; LPP €16,715). In addition, those randomized to the SPP had significant costs during the follow-up from the non-protocol auxiliary psychotherapy treatments (€5142) which were more than fives times compared to the LPP. All of these cost differences between the treatment groups were statistically significant. Psychotropic medication and outpatient care each averaged below €2000, and the differences weren’t statistically significant. Psychiatric hospitalization during the follow-up was rare but yielded significant costs to the associated patients. Differences of effectiveness between the treatment groups on the work ability were not statistically significant. The incremental cost-effectiveness ratio was highly unstable due to small differences in efficiency, but large differences in cost. Conclusions: The study found a clear difference in cost in favour of SPP without losing in the effectiveness of the treatment. However, patients in the SPP used a significant amount of non-protocol auxiliary psychotherapy treatments which may be an indication of insufficient therapy treatment. The absence of difference in the effectiveness can be thus attributed to the widespread utilization of additional treatments in the SPP. Going forward, expanding the study to account for the impact of patient’s suitability to the treatment, particularly in understanding SPP cost-effectiveness, would be worthwhile.