The cost-effectiveness of cognitive behavior therapy for borderline personality disorder: results from the BOSCOT trial

Abstract

Borderline personality disorder places a significant burden on healthcare providers and other agencies. This study evaluated the cost-effectiveness of cognitive behavior therapy plus treatment as usual compared to treatment as usual alone for patients with borderline personality disorder. The economic analysis was conducted alongside a multi-center, randomized controlled trial. The costs of primary and secondary healthcare utilization, alongside the wider economic costs, were estimated from medical records and patient self-report. The primary outcome measure used was the quality-adjusted life year (QALY), assessed using EuroQol. On average, total costs per patient in the cognitive behavior therapy group were lower than patients receiving usual care alone (-689 pounds sterling), although this group also reported a lower quality of life (-0.11 QALYs). These differences were small and did not approach conventional levels of statistical significance. The use of cognitive therapy for borderline personality disorder does not appear to demonstrate any significant cost-effective advantage based on the results of this study.

FIGURE 1

Scatter plot showing the mean difference in costs and QALYs from the trial data (differences based on CBT—TAU).

FIGURE 2

Cost-effectiveness acceptability curve showing the probability that CBT is cost-effective as a function of the threshold willingness to pay for additional health gain.